HSBC Electronic Data Service Delivery Egypt

BACKGROUND VERIFICATION FORM External - Standard Vetting

HR Use Only

Staff ID / National Payroll ID

PERSONAL PARTICULARS

Mr Mrs Ms. Dr

First Name Middle Name

Last Name Former / Maiden Name

Father’s Full Name Father’s Maiden Name

Valid Email: 1)

2)

Telephone numbers (Please mention the International Dialing Codes)

Home Mobile Work

Current Residential Address (Complete in full) Permanent Residential Address (Home country)
(Leave blank if the same as your Current Address)

Country Country

State State

City City

Address 1 (Area) Address 1 (Area)

Address 2 (Street) Address 2 (Street)

Address 3 (Building) Address 3 (Building)

Address 4 (Unit Num.) Address 4 (Unit Num.)

Stayed at this address since: Stayed at this address since:

D D M M Y Y Y Y D D M M Y Y Y Y

Signature : Date : D D M M Y Y Y Y
 If you have lived at your current residential address for less than 5 Years (60 months), please list all addresses you have occupied in the sections below.
There are to be no gaps in the addresses provided. If you were traveling or at a hotel, please indicate so, say “No Fixed Abode” and state what country
you were in.

Previous Address 1 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 2 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 3 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 4 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

*Note: If you don’t have more than 4 previous addresses in the last 5 Years (60 months), please leave the following page blank.

Signature : Date : D D M M Y Y Y Y
Previous Address 5 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 6 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 7 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Previous Address 8 (Complete your address by completing all the fields below)

Country

State

City

Address 1 (Area)

Address 2 (Street)

Address 3 (Building)

Address 4 (Unit Num.)

Postal Code:

Period of Stay From: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Signature : Date : D D M M Y Y Y Y
 PERSONAL PROFILE

Gender Male Female

Marital Status c Married Single Divorced Widowed Separated

Highest Education Level

Birth date D D M M Y Y Y Y Birth Country D D M M Y Y Y Y

Blood Group (This is not mandatory) Birth Governorate

IDENTIFICATION DATA

If you possess more than one Nationality, it is imperative that all passport details are provided below.

Passport Information- Nationality (ies) (*For more than 2 Nationalities, please make a copy of this page & continue)

Country Country

Passport # Passport #

Place of Issue Place of Issue

Issue Date D D M M Y Y Y Y Issue Date D D M M Y Y Y Y

Expiry Date D D M M Y Y Y Y Expiry Date D D M M Y Y Y Y

Residence Visa held on which passport? (Complete if applicable)

Armed Forces Service Record (If Applicable)

Army Navy Air force Police Civil Defense

Regiment / Unit : Service Date: D D M M Y Y Y Y To:

D D M M Y Y Y Y

Rank Attained : Service Number:

Conduct Record:

DIVERSITY DATA (Tick whichever is applicable)

Differently Abled Yes No

Hearing Speech Vision Mobility Learning Respiratory Manual Dexterity

Other:

Referral Source (Tick whichever is applicable)

HSBC Employee Referral PeopleSoft ID #

EMPLOYMENT DATA

1. Have you worked with HSBC Group before? If yes, please mention your PeopleSoft number and staff ID

Yes No PeopleSoft ID Staff ID

2. Do you have any relatives working with HSBC Group? If yes, please provide details below

Yes No

# Full Name PeopleSoft ID Relationship Department Location

Signature : Date : D D M M Y Y Y Y
 ALL FIELDS ARE MANDATORY

The last 5 years of your employment history is required - starting with your present / most recent job

CURRENT or LAST EMPLOYER

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

PREVIOUS EMPLOYER 1

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

Signature : Date : D D M M Y Y Y Y
PREVIOUS EMPLOYER 2

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

PREVIOUS EMPLOYER 3

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

*Note: If you don’t have more than 3 previous employers in the last 5 Years (60 months), please leave the following page blank.

Signature : Date : D D M M Y Y Y Y
PREVIOUS EMPLOYER 4

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

PREVIOUS EMPLOYER 5

Company Name:

Company’s Address: (Street, Area, City, Country)

Department:

Designation / Job Title:

Period of employment: From: D D M M Y Y Y Y To: D D M M Y Y Y Y

Employee Code / Staff ID Number:

Line Manager’s Full Name:

Line Manager’s Contact Number:

Line Manager’s Email Address:

HR Department Contact Person’s Full Name:

HR Department Contact Person’s number:

HR Department Contact Person’s Email Address:

Agency Company Name: (if outsourced)

Agency Contact Number: (if outsourced)

Is / Was this Position:

Salary:

Reason for Leaving (as appropriate) :

Please Tick the Document/s Submitted

for This Employment (It is mandatory to provide supporting documents) Other:

Signature : Date : D D M M Y Y Y Y
 EDUCATION & PROFESSIONAL QUALIFICATIONS

Please only complete the below with the details of your highest level of education (For which you hold a certificate)

Degree/Diploma/Certificate Title

Field of Study

Years attended

University/College/Institute Name

Country

City

Month/Year of graduation

LANGUAGES (Please list the languages known & the proficiency level as: Basic or Proficient or Fluent)

Language Speak Read Write

FAMILY & DEPENDENT PARTICULARS

Your dependents mentioned below will be added to your Medical Insurance based on the countries medical policy.

Please note that you will have to submit the following: √ Scanned copy of a photo

√ Scanned copy of your Marriage Certificate (as appropriate) √ Scanned copy of the Birth Certificates of your children (as appropriate).

Dependent 1

Name in full

Relation Phone number:

Date Of Birth D D M M Y Y Y Y

Gender Marital Status Add to Medical Insurance?

Address details

Dependent 2

Name in full

Relation Phone number:

Date Of Birth D D M M Y Y Y Y

Gender Marital Status Add to Medical Insurance?

Address details

*Note: If you don’t have more than 2 previous dependents, please leave the following blank.

Dependent 3

Name in full

Relation Phone number:

Date Of Birth D D M M Y Y Y Y

Gender Marital Status Add to Medical Insurance?

Address details

Signature : Date : D D M M Y Y Y Y
 EMERGENCY CONTACTS (If addresses of your Emergency Contacts are same as your address, please do not mention)

Primary Contact Secondary Contact

Full Name: Full Name:

Relation to you: Relation to you:

Address: Address:

Phone Home: Phone Home:

Phone Work: Phone Work:

Phone Mobile: Phone Mobile:

BENEFICIARY DETAILS

In the event of my death, I hereby direct the Bank to pay the proceeds of any Insurance benefits as per the following:

To the below named person(s) in the percentages(%) specified and /or As per Shariah Law

Beneficiary No :1

Name in full

Relation to you Phone number:

Gender % of Proceeds

Address details

Beneficiary No :2

Name in full

Relation to you Phone number:

Gender % of Proceeds

Address details

DECLARATION AND CONSENT

1. Have you been convicted by the police for any offence? Yes No

If yes, please provide details:

2. Have you ever taken active part in politics? Yes No

If yes, please provide details:

3. Have you ever been refused a loan or credit card or been blacklisted? Yes No

If yes, please provide details:

I certify that the information provided in my application form is true and can be treated as part of any subsequent contract of employment.

I also understand that any untrue information given in this application will result in disqualification or termination of employment with HSBC
Group even if the application is successful.

Name

Signature : Date : D D M M Y Y Y Y
 DOCUMENT CHECKLIST – The below data are mandatory

1. Background Verification Form (BVF)

a. All 12 pages to be sent in a single PDF document

2. Updated Resume / CV

a. To be sent in a word document format

3. Original Education Certificate + Copy.:

a. Copy of Highest degree certificate

4. Employment Verification: (for the last 5 years)

a. Original experience letter / clearance form (If Any)

b. Contract/Offer Letter AND Last 3 months Payslips (where experience letter not available - i.e. Current employment)

5. ID Proof:

a. 3 Valid National Id Copies.

b. Original Military Certificate. - (As appropriate)

c. Original Birth Certificate (new form) + Copy.

d. Original Criminal Record Addressed to (HSBC Electronic Data Service Delivery).

6. Photograph

5 Personal Photos with White Background.

7. Governmental Requirements:

a. Work Permit for Egyptians.

b. Most Updated Social Insurance Print.

c. Form “6” Soc. Ins. From Previous Work (If Any).

Signature : Date : D D M M Y Y Y Y

Human Resources may advise of additional documents that might be required for vetting and you would need to provide the same when advised. Please ensure
providing the documents on time or otherwise your offer may be void.