Employment Form ValueLabs

Joining Report Form

To,
The Head-HR
Valuelabs
Plot No.41, Hitech City, Phase-l!
Madhapur, Hyderabad-500081

Dear Sir,
This is in reference to my, offer letter date I am happy to report to duty as (designation)

Exectivesksnck ' (location) Hideka.esasd with effect from (appointment date) R . : 1 . in

(department). ap.is.h.
In consideration of your offer and my acceptance to joining Valuelabs, I hereby agree and undertake to hold you harmless
and to keep you indemnified from and against all claims, demands, actions, suits, losses, costs, charges, expenses, damages
and liabilities losses, which you may sustain, suffer or incur by reasons of or in connection with any kind of obligations or
commitments I may have towards my previous, past organizations or any bank.

I agree and undertake to pay any such losses, damages or expenses upon demand being made by any party on my behalf.

Thanking you,
Yours faithfully,

kRove
(SIGNATUXE)

Name: KASLA. REVANTH

Date: 3ol4l2o21
Place: BHADRACHALAM

Valuelabs, India. 2021 Confidential Page 1 of 4

 Employment Form Valuelabs
Employment Form

Personnel Detalls
Name in Ful
KAsdLA:REVAN TH
City,Country: BHAPEACHALAM 1NDLA
Nationality LNDIAN
Contact Details:
9q122803*5-
Email 1D:
RRE VANTHH k Marital Status:
GMALL.CoM
(Please tick whichever is
Gender:(Please tick whichever is applicable):
Male/Female applicable): Single/Married

Passport Details
Do you possess Passport
NA () Yes(If Yes, Please provide the below details) (No
Passport No: Date of Issue: Valid Up to lssued By: Place:

Visa Details
Have you ever travelled abroad? (Yes (1 No (ifYes, please providethebelow details)
Countries Visited: Year of Travel:

Has your Visa ever been rejected /refused by any Consulate? () Yes ( ) No (ifYes, please provide the below details)

General Information
If Yes, Please provide the details
Are you currently engaged in any other business as a Yes/No
proprietor, partner, officer, director, trustee, employee, or ND
agent or otherwise?
Have you ever been arrested for or convicted of a criminal Yes/No
offence? No
Have you ever been declared bankrupt? Yes/No
No
Have you ever had any civil judgments made against you? Yes/No
NO

Do you know or are you related to anyone who works for Yes/No
Valuelabs? Mang Pcdeti
Education Details
Level Schooling Pre-Graduation

O Valuelabs, India. 2021 Confidential Page 2 of 4

 Employment Form
ValueLabs
Name of the School/College Stauls hhe
Duration of the Course From- To (Year) al-2AI2
Year of Passing 12
Class& Percentage
Address Details
sita Ka 9
kalay, Bhdhda
SoHlL
Graduation
University Name: College Name: /Mela te day clleqe College Address &Telephone Number:
TNTO H Lenga P Tendoy Mysanmaguda, yderabad
| From- To (Year):2DlS- 18| Graduated:
MYes () No Program: MFullTime( )Part Time
Stream of Degree ECE Specialization 1EcH
|Post-Graduation Please Mention 'NA', if this section does not apply
University Name: College Name: College Address & Telephone Number
NA
From- To (Year): Graduated OYes ()No Program: (O Full Time ( ) Part Time
| Stream of Degree Specialization

Please acountfor anydiscontinuationin youreducationtenure. Mention'NA',ifthissectiondoesnot apply

Discontinuation (Education) From To Reason

Employment Section
Kindly provide details of previous employment

Employer-1
Organization Name Employee ID: Last Designation Held:
VALUELA BS Custmes Suffo
ExectiVe
Address Details a l u lht Solutions u p Period ofEmployment: Type ofemployment:
Phoen Ciy, achi besli From: 519/l2e 2o )Permanent
Ullage To: 21|2021 MTemporary
HR Contact Details Supervisor contact Details
Name of the HR Name of the Supervisor
Ashwin Icolluxu
Designation Custome SPPt Designation
Contact Details Contact Details
Custome Suos Mange
95819 ug11 95o 521563
Email ID Email ID

If worked at Client Location then:

O Valuelabs, india. 2021 Confidential Page 3 of 4

Employment Form
Valuelabs
Name of the Raporting Manager
Clent Name
Address If the Clilent: Designation
Contact No:

Email 1D:

Last Drawn CTC Reasons for Leaving

Mention 'NA', If this section does not apply

Please account for any discontinuatlon in your employment tenure.

From To Reason
Discontinuation (Employment)
NA

Declaration to besigned by the employee

Valuelabs. I hereby
is accurate and subject to verification by
Icertify that the Informatlon furnished in the joining forms and 1 do
and when required by the company or its representatives
give my consent to investigate any of the components as that this background
not hold ValueLabs liable for any actions or situatlons
that may arise by such checks. I understand
and additional checks specific to its dient
verification will include, but not be limited to Education, employment history
records verification.
needs like substance abuse, credit verification and criminal
to the clearance of background check.
laccept that my employment with Valuelabs subjected
is

time the particulars are found to be untrue, incorrect or incomplete;

agree and accept without reservation that if at any
that the cormpany is
be revoked and or terminated without any notice. I confirm
my appointment in the company may
to the extent necessary in connection with the services, which
I
entitled to share such investigation report with its clients
may be required to provide to such clients

Name in Capitals: ASoLA. RE VAN TH

Date: 3olul2or
Signature of emptoyee
Place: BHADRAUHhLAM

Confidential Page 4 of 4
ValueLabs, India. 2021
 Nomination and Declaration form for
FORM 2 (REVISED) Unexempted /Exempted Establi shmen ts

Declaration and Nomination Form under the Employees' Provident

Funds and Employees' Ponsion Scheme

(Paragraphs 33 & 61(1) of the Employses Provident Fund Scheme, 1952 and paragraph 18 of the Employees' Pension Scheme, 1995)

1 Name (in Block Letters)

KASULA ReVANTH
2. Father's Rusband's Name KASULASP2NIYASA RAOo
3. Date of Birth
o2o5 1926
4Sex
MA LE
5. Marital Status S1NGLE
6. Account NO.
AR/HYD/44446/
Addresss Permanent
LBaNAna, Jagodeeh cdony
BHApE ACHALAM So2L
remporary
LeaatA Jegadesh celoay
Ghedsachal am To4LlL
8. Date of Joining 3olul2o2-
PART - A (EPF)

I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the persons) mentioned below to
receivethe amount standing to my credit in the Employees' Provident Fund, in the event of my death.

Date of Total amount of share fthe nominee is a

Name of Address Nominee's of accumulations in minor, name&
Nominee relationship Birth
Provident Fund to be relationship & address
Nominees withthe paid to each nominee of the guardian who
member may recerve the
amount dunng the
minority of nominee
6

k-BHARA THI |LBGaNage

Jag ade eh
Mohes 3ols>
calny 507U|
Bhadachalam

Ceruifid that I have no family as definedinpars 2g) of the Employes' Provident Fund Scheme, 1952 and should I acquire a family bereater the
cancelled.
above nomination should be deemed as

Cerified that my father/ mother is/are dependent upon me

 PART B (EPS)

I hereby funish below particulars of the members of my family who would be eligible to receive widow/children pension in the
event of my death.

Name &Address of the Family Member

SNo Date of Relationship with
Name Address Birth Member
3 5

*Certified that I have no family as defined in Para 2(vi) of Employees Pension Scheme, 1995 and should I acquire a family hereafter I shall fumish
particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension (admissible under Para 162 (a) (i) and (i) in the event of my death
without leaving any eligible family member for receiving pension.

Name and Address of the Nominee

Date of Birth Relationship with Member

Date: 3dyl22 OeXL

Signature or Thumb Impréssion of the Subscriber
Strike out whi chever i s not applicable

CERTIFICATE BY EMPLOYER

Certified that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smt./Kum.

REVRNIH... . employed in my establishment after he/ she has read the

entries/ entries have been read over to him/ her by me and got confirmed by him/ her.

Establishment Seal & Address Stamp

Place: HYDERABAD * *

Signature of the employer or other

Authorised Officers of the Establishment
Dated:3olylz.
"***********"*****'*********

Designation: S+AStAEMSP xec uve

Strike out which ever is not applicable. Signature or Thumb Impression of the Subscriber
Payroll Form-Details of New Employee
ValueLabs
Particulars To be filled by employee
Employee I0:
Employee Name:
I5822
(first, middle &lastname) kAsULA. REVANT+
Father's Name:
Date of Joining (DD-MM-
k. SR1NiVASR RAO
YYYY): 20-0y- 2021
Date of Birth: (DD-MM-YYYY):
O3-05-(216
Address: |LBG NAGAP, JAGADESH CoLoN Y (--22
BHARAHRLAM, GHADPADR1 (CoTL Anu oEM DLST
Mobile Number:
92226345
PAN Number:

AADHAR Number:
FPEPE1420A
5268 q61 4o84
ESI Number (if any):

List of Documents to be submitted to payroll Previous Income Details (1-4-2016 to LWD)

Name of Document Agreed last date of submission
Submission Status (Yes/No
Provisional Form 16 / Tax in case of delay)
computation sheet:
Note:
Only Gross amount will be considered in case of
Pay slips submitted as previous income proofs.
PF transfer will be initiated from the
employee once you get a new PF account number from
PAN & AADHAR numbers are ValueLabs
mandatory. A photo copy of the same to be submitted.
If the DOJ is after 21st of the month,
salary processing will be done in the next pay cycle.
Employee will be receiving the salary cheque, if incase account details are not updated in the intranet
portal.

Employee Signature
Office Use (to befilled by the HR and Payroll:
Project Name:
Employee ID
Project Manager Skill Set:

Gross CTC: HR Database

Variable Pay: Remarks:

Requirement of Bank Authorization from HRR
Account: Department

OValuelabs, India, 2021 Confidential

Page | 1
 DECLARATION FORM FORM 1

Employer's Code No.

A) Imsured Person's Partleulars () Employer's Particulars
1Inurance No. Day MonthYear
10. Date of
Name Appolntment
in block capitald AsOLA. REVANTH
ather'
11. Name Aderess of the employer
Husband's Name KSeiNLVASA RAO
4 Date of Dith
DD MM YY . Martial Stalus M/UW
7 Present Address
l3osl14hSe
. Permanent Addresw

LBaNagay Jagded agydeh

abny.Bhndchalamelony.&loadedhdan 12. In caso of any prevlous employment
please fillup the details as under
Rhadnd ketAaa.de d ra kdharden|
Dut (9-- 2sA Du HoI7-2-2nlPrevlous In. No.
Pin:6EOUU Pin D UU Emplra.Code No
email address oMmall address Cw 11. Name & Address of the employer
RKEVANTHHkOGMtLLRREVANTHH e bmAlL|
Branch office:
Dispensary
to Details of the nomineeus 71 of ESI Act1948/Rule56(2) ofESI (Central) Rules1950 for paymentofcashbenefit in the event ofdeath
Name of the Nominee Relatlonship wlth insured person Address

thereby declare that the above particulars have been given by me andare correct to the best of my knowledgeand 1 beliel. I also under take to
intiryatetothe corpoation any change In the membership of my family within 15 days of such change having occured.

Couhter slgnatureolhétmployer

Signature / T.I. of I P
Signature with Seal

(D) FAMILY PARTICULARS OF INSURED PERSON

Relationship with | Whether reslding with | f No, State place of
SI. Date of Birth
Name
No. insuredperson him/her or not Residence_
YES NO TOWN STATE

ESI CORPORATION
Valid for 3 months from the date of appointment
TemporaryIdentity Card
Name
|Ins. N Date of Entry
(Space for photograph)
Father's Date of Birth
Husband's Name
Branch Office DispensarY

Name, Address &

Code No. of the

employer

Validity Signature/ T.l. of IP Signature of B.M. with Seal

Dated
 INSTRUCTIONS

Submisalon of Form 1le governed by regulations 11& 12 of ESI (General) Regulations, 1950

Family means all or any one of the following relatives of an insurnd person namelyi
) a Spouse (d) a minor legtimate or adopted chlld dependent upon the L.Pa ( ) a chlld who ls wholly depondent on the earnings of
the I,P and who Is (a) recelving educalion, i) he or she altaine the age of 21 years (b) an un marrled daughtery (lv) a child who is lnlirn
by reason of any physlcal or mental abnormallty or lnjury and s wholly dependent on the earnlngs of the 1.P, s0 tong as the infirmly
Ontinues; () dependent Parents

3ldentity Card is Non Tranferable

4Loss of ldentity Card be reported to Employer / Branch manager inmodlately

Submission of false Information attracts penal actlon under sectlon 84 of ESI Act, 1948

6This form dully filled in must reach the concerned Branch offlce wlthin 10 Days of appointment of an employee, Delay attracis penal
action under section 85 of the Act, agalnst the employer

As an insured person you and your dependent familly members are entitled to full medical benefit from today itself. The other benefits
in cash include (1) Sickness Benefit (2) Temporary Dlsablement Benefit (3) Permanent Disablement Benefll (4) Dependents Benefit and
(5) Maternlty Beneflt dn case of women employees) sublect to fulfillment of contributory conditlons

8 For more details contact website of ESIC at www.eslc.org.in or contact Reglonal offlice or Branch offlce

FOR BRANCH OFFICE USE ONLY

1. Date of allotment of Ins. No.

2. Date of issue of T.I.C

3. Name / No. of Disp.

4. Whether reciprocal Medical arrangements involved, if yes, Please indicate

Signature of Branch Manager

SI. Relationship with Whether residing with If No, State place off
Name Date of Birth
No. insured person him/her or not Residence
YES / NO TOWN STATE
 New Form No.11- Declaration Form
To be retaioed by the employer for fatnre reference

EMPLOYEES PROVIDENT FUND ORGANIZATION EmpCode

Employees providet funds scheme. 1952 (paragraph 34&57)&
Employees pension scheme 1995 (paragraph 24)
Company: YyALuGLAR
(Declaration by a person taking up employment in any establishment on which EPF Scheme. 1952 end iof EPS1995 is applicahic)

Nane of the member

kASULA ReVANTH
2 Father'sName Spouse's Name () -SRIN1VASA RAO
PlcaseTick WhicheverIs Applicable)
Darc of Birth (DDMMYYYY o3 05 |>196
4 Gender( male Female Transgender MALE6
5 Marital Status (married Unmariod widow divorce) hMad1ttd
(2Email ID: KRev ANTHH: k@GIAZC.LM
bMobile No:
Whether earlier a mcmber of Employees provident Fund Scheme 1952 Yes No
8 Whether carlie a member of Employees Pension Scheme.1995 Yes No
9)
lf response to any or both of (7) &(8) aboveis yes. MANDATORY FILL UP THE (COLUMN
a) Universal Account NumberUAN) lolGiy3 12644
b)Previous PF a'c No AP HD EST.CODE EXTN PE NO.]
c)Date of exit from previous employ ment (DDMMYYY)
d) Scheme Cerificate No (if Issued)
e) Pension Paymet Ordar (PPO)No (if Issued)
a) Imerational Worker. Yes No
10 if Yes.State Country Of Origin(lndia Name of Other Country)
Passport No
Validitry Of Passport (DD/MMYY) to(DD/MMYYY_
KYC Detais: (attach Self attested copies of following KYCs)**
a) Bank Account No & IFS code
610 ol51385982 1L1coo0162
11 b) AADHAR Number (12 Digit) S268 6| 4oR4
c) Permanent Accout Number (PAM)Ifavailable IF PKPEaY20}
UNDERTAKING

) Cartified that the Particulars are true to the best of my Knowledge

KYC purpose for service delivery
1 anhorize EPFO to s e my Aadher for verification/
e
2) declared above to the
if applicable, from the previous PF account as
3) Kindly transfer the funds and scrvice details, if applicable has
preset P.F Accou The Transfer Would be possible only if the identified KYC details approved by previous employer
been verified by presert employer
Will be intimate to ermployer at the earliest
4) In case ofchanges In above details the same

Dae: 3o yl2j . kKoua

Signatüre of Member
Place Bhodhhalam
DECLARATION BY PRESENT EMPLOYER Number.
been allotted PF ***

K:KeVas thas joined on3ol4lat.and has

***********

A) The member Mr Ms s EPS, 1995

wzs carlica not a member ofEPF Scheme .1952 and
B)in case person
member is..
of UAN) The UAN Alloned for the
--- - - -

( P o s t allotment
lease tsick the Appropriate Optioe:
database
The KYC detals ofthe above member in the UAN
Have not beea uploaded
Have been uploaded but not approved
Have been uphoaded and approved with
DSC

member ofEPF Scheme 1952 and EPS, 1995

C)in case the person was eaiicr a
,

mentioned in (a) above has been tagged with

his /her UAN/previous member ID as
member
T h e above Pf aocount nurnber
UAN ofthe as

deciared by member
Peae Tics the Appropriate Optio
approved with digital signature Certificate and
transfer request
The KYC details of the above member
in the UAN database have been
has been geTTed on portal
file physical claim (Form13) for transfer
With EPFO the member has been infomed
to
As the DSC ofestablishrment are not registered
establishment
of funds from bis previous

Da 3 4 l 2
kkov
Signatùre of Employer With seal of Estabiishment