DECI.

ARATIONS

1. Criminal reco.d declaration:

Have you ever been convicted by the courts or cautioned, reprimanded or given a final warning by the
police? Ifyes, please give details of offences, cases, penalties and dates as per the table below. Your
offer would be dependent on clearance br7 our legal team on this aspect. lf no, please right NA across
the table below.
Date of ldentificati6n no. (FlR/ Details of the incident (city, court, what
incident Case no.) happened etc)
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D
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2. Iyrdlrcal fitness

declare that I am fit to work and I have no diseases or iltnesses whatsoever which preclude
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me from working effectively in the role that I am applying for or for any other role in future with HDFC
Life or its subsidiary or group companies.

3.,lforking Relatives Declaration

!z/hereby declare that I have no relatives (siblings, parents, spouse, parents-in-law, children, siblings
of spouse) working in HDFC Life as an employee or associated as an agent or a vendor as on date.

E I hereby declare that I have the following relative(s) working with HDFC Life as an employee or a

vendor or agent

/ Agent code declaration

hereby declare that I have no other E-code / Agent Code from any other company.
OR

Ll I hereby decla re that I have the following e-code / Agent Code. I agree to deactivate it as per
process if I join HDFC life

Name and signature of the employee with date

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