Candidate Declaration Form

VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

Instructions: Please provide all the information requested in this form. Incomplete Candidate
Declaration Forms (CDFs) will be returned. All supporting documents must accompany this form.
Photocopies must be legible. We have included a checklist to assist you to complete your
application comprehensively.

PERSONAL DETAILS

Full Name (First/Middle/Last): Prajwal Shankar Kanpurwar _

Fathers Name/Husband’s Name: Shankar Kanpurwar

Date of birth (DD/MM/YY): 09/03/1997 Contact Number:+ 917588111608 Nationality: Indian _

Passport Number: R9781024 Date of issue: 26/06/2018 Date of expiry: 25/06/2028 _

PAN Number: HEKPK2609A _ Blood Group: O+ve

Personal email id: prajwalkanpurwar1234@gmail.com _

DL number: 33/2015001910

Voter ID number: UZB7009160 _

Change of Name if Applicable

Former Name/Maiden Name : Date

of Name Change :

Current Address Permanent Address

Door No/Street: Rampuri Tukum Ward No.7 Door No/Street:

City: Gadchiroli _ City: Gadchiroli _
State:Maharashtra State:Maharashtra
Pin:442605 Pin:442605
Landmark: Behind City Hospital _ Landmark:Behind City Hospital
Period of stay: 12 yrs Period of stay: 12 yrs
Landline/Mobile No. +917588111608 _ Landline/Mobile No. +917588111608 _
Is your residence own or a rented place? Own Is your residence own or a rented place? Own
If rented, please provide details of the Landlord If rented, please provide details of the Landlord
Name: _ Name: _
Address: Address:
City: City:
State: _ State: _
Pin: Pin:
Landline/Mobile No. _ Landline/Mobile No. _

Proof of Address: (Photocopy of Passport / Last Paid Land Line/Mobile Phone Bill/ Bank Account Statement/
Rent Agreement Copy/Driving License/ National Identity Cards)

For Internal Use Only

VFG ID: (To be entered by Verifacts personnel only)
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 Candidate Declaration Form
VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

EDUCATION DETAILS

Client Requirements
Highest Graduation * Post Graduate
Name of the Course MCOM- MARKETING & FINANCE
Student ID No/Enrolment No 10572 Duration of Study 2 yr
Division/Class A Degree Obtained MCOM
Subject Major Marketing Course Type (Regular/Distance) Regular
Name of University Savitribai Phule Pune University
Name of College/Study Centre Mamasaheb Mohol College
Address of Institution Paud Road Erandwane, Kothrud,Pune
City:Pune State: Maharashtra
Pin:411038 :(Landline) 020-25431034
: (Email ID) mmc_paudroad@pdeapune.org

Note: Please attach legible photocopies of the following documents relevant to the entries above
*Interns can mention the course they are currently pursuing

1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK

3) Provisional Certificate 4) School Leaving Certificate

EMPLOYMENT
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.

Immediate Previous Employment

PERMANENT EMPLOYMENT
Haritha Technologies PVT.LTD.
Name of Company
Where were you employed?  Registered Corporate Office  Branch Office

Company Address Door No/Street

(Where you were employed) City Pune State Maharashtra

Pin 411035  (Landline)

1.6 Years 0216
Period of employment Employee Code
Business Development Executive 3.6LPA
Designation Remuneration
B to B Sales Haritha Automotive parts
Department Reported to
Sales Executive harithatechnologies.co.in
Supervisor’s Designation  (Email Id)
Personal work at Home
Reason for Leaving
CONTRACTUAL EMPLOYMENT

Company Name

Company Address Door No/Street

City State
Company Contact Person  (Email Id)
 Candidate Declaration Form
VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

Business Development Executive

Designation  (Landline)
State you reason for leaving Personal work at Home

Can a reference be taken now?  Yes  No

If No, when can it be taken?

Note: Please attach legible Photo copies of the following documents relevant to the entries above
Appointment Letter, Salary slips and Release Letter / Service certificate

Authorization/ Declaration and Undertaking

If employed by Think & Learn Pvt Ltd, I agree to provide copies of all relevant certificates. I understand that employment
with Think & Learn Pvt Ltd is governed by their employment policies as applicable, including satisfactory information from
background checks.

I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
Think & Learn Pvt Ltd and its representative to authenticate information I have provided in my resume and this Candidate
Declaration Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I authorize all who may
have information relevant to this enquiry to disclose it to Think & Learn Pvt Ltd and/or its representative. I release all
concerned from any liability on account of such disclosures.

I also declare that the information provided by me in my resume and application for employment at Think & Learn Pvt Ltd
and its representative is authentic and I am liable for all inaccuracies and omissions.

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: Prajwal Kanpurwar Signature of the Candidate

Place Nagpur

Date: 11/12/2020
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