SELF EXPLANATORY

SAIPEM INDIA PROJECTS PRIVATE LIMITED

S A I P E M I N D I A P R O J E C T S P R I V A T E L I M I T E D

EMPLOYEE NAME : YOUR FULL NAME STAFF NO : YOUR D.O.J

DESIGNATION & LEVEL : REFER YOUR OFFER LETTER DEPARTMENT : REFER YOUR OFFER LETTER

FATHER / HUSBAND NAME : YOUR FATHER OR HUSBAND NAME BLOOD GROUP : TO BE FILLED

To : HRD, SIPPL ., Chennai - 34. MOBILE NO: YOUR PERSONALMOB NO.

Thank you for your appointment letter to me as REFER YOUR OFFER LETTER in your organisation, and report for duty
with effect from YOUR D.O.J I hereby given below my personal datas for your kind reference.

Qualification :
QUALIFICATION YEAR OF PASSING UNIVERSITY COLLEGE

U G DEGREE TO BE FILLED TO BE FILLED TO BE FILLED

P G DEGREE " " "

DIPLOMA " " "

Previous Experience :

1) ORGANISATION NAME : FILL ALL YOUR EXPERIENCE DETAILS Total Yrs & Months

From To

2) ORGANISATION NAME :

From To

3) ORGANISATION NAME :

From To

4) ORGANISATION NAME :

From To

5) ORGANISATION NAME :

From To

6) ORGANISATION NAME :

From To
 SELF EXPLANATORY

S
SAIPEM INDIA PROJECTS PRIVATE LIMITED
A I P E M I N D I A P R O J E C T S P R I V A T E L I M I T E D

7) ORGANISATION NAME :

From To

8) ORGANISATION NAME :

From To

9) ORGANISATION NAME :

From To

10) ORGANISATION NAME :

From To

Total Expereince in Years & Months TO BE FILLED

Date of Birth
Sl.No Members Name Relationship DD/MM/YY Age

1 EMPLOYEE NAME Staff TO BE FILLED TO BE FILLED

2 SPOUSE NAME (IF APPLICABLE ) Spouse " "

3 CHILD NAME 1 (IF APPLICABLE ) Child 1 - Male/Female " "

4 CHILD NAME 2 (IF APPLICABLE ) Child 2 - Male/Female " "

5 FATHER NAME Father " "

6 MOTHER NAME Mother " "

Staff wedding date: (DD/MM/YY) TO BE FILLED

Present Address : Permanent Address :

TO BE FILLED TO BE FILLED

" "

" " TO BE SIGNED

" "

Telephone No: TO BE FILLED Telephone No: TO BE FILLED

Emergency Contact No: TO BE FILLED

E-Mail: YOUR PERSONAL E-MAIL ID (Signature of the Staff)

 FORM FOR ID CARD

:
NAME YOUR FULL NAME

:
STAFF NO. DO NOT FILL

:
DEPARTMENT REFER YOUR OFFER LETTER

TO BE SIGNED STICK THE WHITE

BG
PHOTO

SPECIMEN SIGNATURE PHOTO

 Declaration

I hereby declare that, I am not related to any of the Directors / Board members of
Saipem India Projects Private Limited.

(Signature)

Name : YOUR NAME TO BE SIGNED

Staff No : DO NOT FILL

Department :
AS PER OFFER LETTER
Date :
YOUR D.O.J

Declaration

I hereby declare that, I don’t have any relatives working with Saipem India
Projects Private Limited.

Name : YOUR NAME

Staff No : DO NOT FILL
Date : YOUR D.O.J
TO BE SIGNED

(Signature)
 Annexure - B

Code Of Ethics Acknowledgement

I hereby acknowledge that I have been provided with and in have read a copy of the
Saipem Code of Ethics.

I understand that the Code of Ethics contains principles and terms which I agree to
abide by, always in the respect also of local legislation and regulations, throughout
the course of my employment with Saipem India Projects Private Limited.

Date: YOUR D.O.J

Employee Name: YOUR FULL NAME

Employee Signature: TO BE SIGNED

 Policy on Internet / Email

E-Mail and Internet Service Regulation

Scope and Objective : The scope is to define the rules that SIP Users shall conform to,
in order to establish a correct use of electronic mail and Internet Services. The
Objective is to assure that SIP working environment and image are protected against
actions conflicting with its rules to the Internet Service and Electronic mail.

Rules : Email and Internet Services shall be used exclusively for work reasons and
within everyone’s competences. Furthermore, it is considered as prejudicial to the
Company’s ethics the following actions:

Electronic Mail

The use of the electronic mail to disclose information about SIP and Saipem Group or
likely to have an effect on the Companies and on the Group’s image (ie plans,
programs, initiatives) shall be previously authorized by the Company.

• Unauthorised access to electronic mail

• Unauthorised access to other User’s electronic mail boxes
• Use of the electronic mail system to disclose confidential and/or defamatory
intelligence about the Company, its employees and its clients
• Use of the electronic mail to send and receive obscene materials evidencing
discrimination based on race, national origin, gender, sexual orientation, age,
disability religion or political beliefs.
• Use of the electronic mail to send or receive material that is not related to
work.

Internet Services

The use of the Internet shall be consented exclusively for business purposes within SIP
activity context. The Internet navigation shall be exclusively aimed at retrieving
information and documents related to working activities. The following actions are
considered as prejudicial to the Company’s ethics

• Access to the Internet by unauthorized employees

• Use of the Internet to access sites containing obscene, pornographic material,
Sites non related to work
• Use of the Internet to access to unauthorized software.
 Declaration of Acceptance of the Email and Internet Service Regulation

I, the undersigned YOUR FULL NAME Staff.No. DO NOT FILL declare the full
acknowledgement and unconditioned acceptance of the attached Regulation
and I bind myself to use these services in total compliance of the same.

I also declare to be fully liable with regard to SIP and Third Parties for any
damage or inconvenience caused by the non-respect of the Regulations and, in
general, caused by misuse of the Internet and/or External Electronic Mail
services on my part.

Date :YOUR D.O.J Signature. TO BE SIGNED

 See sub-rule (1) of Rule 6 of the Tamil Nadu Payment of Gratuity Rules, 1973
FORM F NOMINATION
To : SAIPEM INDIA PROJECTS PRIVATE LIMITED, MILLENIA BUSINESS PARK PHASE II , CAMPUS 3A - FLOORS 3,4,5,6 & 7,No: 143, Dr.M.G.R Road (North Veeranam Salai), Kandanchavadi ,Perungudi ,
Chennai - 600096

YOUR FULL NAME

1. Mr/Ms…………………………………………… whose particulars are given in the statement below ,hereby nominate the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity
standing to my credit in the event of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against
the name(S) of the nominee(S).
2. I hereby certify that the person(s)mentioned is a are member's of my family within within meaning of clause(h) of Section 2 of the Payment of Gratuity Act 1972.
3.I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the said Act. 4.
(a)My father/mother/parents is/are not dependent on me.
(b)My husband's father/mother/parents is/are not dependent on my husband.
5.I have exclued my husband from family by a notice dated the….to the Controlling Authority in terms of the proviso to clause (h) of Section 2 of the said Act.
6.Nomination made herein invalidates my previous nomination.

NOMINEE(S)
Proportion by which gratuity will be shared
NAME IN FULL WITH FULL ADDRESS OF NOMINEE(S) Relationship Age of nominees
NAME ADDRESS

YOUR NOMINEE NAME (E.G. YOUR YOUR NOMINEE MENTION IN PERCENTAGE

YOUR NOMINEE ADDRESS
YOUR FATHER OR MOTHER NOMINEE AGE (e.g. IF 1 NOMINEE 100% /
OR SPOUSE) RELATIONSHIP IF TWO NOMINEES (e.g. EACH
50 %)
 YOUR FULL NAME & COMPLETE PERMANENT ADDRESS STATEMENT

1. Name of the employee in full……………………………………………..2..Sex……………….3. Relegion…………….. 4.Whether unmarried/married/widow/widower……………………………………

5.Department/Branch/Section where employed………………………………………………….Post held with Ticket No. Or Serial no. if any…………………………..7.Date of appointment

…………………………8.PermanentAddress………………………………………………………………………………Village…………………………………………NearestPoliceStation…………………………………………..

……………………Taluk………………………………………..PostOffice………………………………………District……………………………………..state…………………………………..

TO BE SIGNED BY YOU
Place:
CHENNAI
Date : Signature / Thumb – Impression of the employee
YOUR D.O.J

DECLARATION BY WITNESSES
Nomination Signed / thumb – impressed before me

NAME IN FULL AND FULL ADDRESS OF WITNESSES SIGNATURE OF WITNESSES

1 1

2 2

Place:
Date :
CERTIFICATE BY THE EMPLOYER
Employer’s Reference No, If any Certified that the particulars of the above nominations have been verified and recorded in this establishment

Name and address of the establishment of rubber stamp therof

Date:
Signature of the employer / Officer authorised Designation

ACKNOWLEDGEMENT BY THE EMPLOYEE

Received the duplicate copy of nomination in Form F filed by me and duly certified by the employer
TO BE SIGNED BY YOU
YOUR D.O.J NOTE: Strike out the words/paragraphs not applicable
Date: Signature of the employee
49568

YOUR D.O.J
YOUR D.O.J

YOUR D.O.J
 JONT DECLARATON FORM - I

[Form to be used for enrolling to the Employees’ Provident Fund in respect of the employees whose
Total wages exceed the wages ceiling limit of Rs.15,000/- per month on the date of joining the
establishment and for remitting the P.F. contributions as per Statutory Rate only]

(See Paragraph 26(6) and Para 29 of the Employees’ Provident Scheme, 1952)
--------

To
The Regional Provident Fund Commissioner,
Chennai

Declaration by the Employee:

YOUR FULL NAME

I,_____________________________
YOUR FATHER/SPOUSE NAME
Son of / Daughter of / Wife of __________________________
Bearing Provident Fund Account No _TN_/__49568_/_______
Am willing to become member of the Employees’ Provident Fund Scheme, 1952 with effect from
YOUR D.O.J
________________ and to contribute to the Employees’ Provident Fund at the Statutory Rate as
prescribed under Para 29 of the Employees’ Provident Fund Scheme, 1952 on my Emoluments consisting
of Basic Pay, Dearness Allowance (including cash value of food concession) and Retaining Allowance (if
YOUR D.O.J
any), which altogether not exceeds Rs.15,000/- per month with effect from ________________.

I agree to abide by the conditions contained in the Employees’ Provident Funds Scheme, 1952.

Therefore, kindly permit me to enroll myself as Member of the Employees’ Provident Funds and
to contribute on my Emoluments not exceeding Rs.15,000/- per month with same benefits as available
to other Provident Fund members whose monthly salary does not exceed Rs.15,000/- with effect from
YOUR D.O.J
________________.

CHENNAI
Place: YOUR SIGNATURE
Dated: Signature of the Employee
YOUR D.O.J

Declaration by the Employer

We, as the Employers of the above mentioned Employee are willing to pay our share of
contributions to the Employees’ Provident Fund at the Statutory Rate as prescribed under Para 29 of the
Employees, Provident Funds Scheme, 1952 on the Emoluments of

YOUR FULL NAME

Shri / Smt / Ms ________________________________ consisting of Basic Wages, Dearness Allowance
(including cash value of food concession) and Retaining Allowance (if any), which altogether not
exceeding Rs.15,000/- per month and agree to remit the Administrative Charges at the existing
prescribed rate of 0.65% of the wages of the above employee on which the Provident Fund
YOUR D.O.J
contributions are payable with effect from ________________and also agree to abide by the conditions
contained in the Employees’ Provident Funds Scheme, 1952.

The above Employee, may therefore be permitted to become Member of the Employee’ Provident
Fund and to contribute on the emolument not exceeding Rs. 15,000/- per month from the aforesaid
date.

DO NOT SIGN
Place: CHENNAI Signature of the Employer or
Dated: YOUR D.O.J Authorized Official with Seal.

For Office use:

OFFICE OF THE REGIONAL PROVIDENT FUND COMMISSIONER

The above Joint Declaration is accepted and necessary entries made in the Ledger Account of
the Employee for verification with the Contribution Card in From 3-A.

A.O. (with Seal) A.P.F.C. (with Seal)

To
01. Shri / Smt / Ms YOUR FULL NAME
P.F. Account No. _TN_/_49568_/_______ (Through the Employer)

02. M/s
(* Address Seal of the Establishment)

03. Area Enforcement Officer

Note: 1. This Joint Declaration is required to be submitted in Quadruplicate.

2. Recovery of P.F. contribution may be started in anticipation of formal acceptance.
-----
 New Form : 11 - Declaration Form
(To be retained by the employer for future reference)

EMPLOYEES' PROVIDENT FUND ORGANISATION

Employees' Provident Fund Scheme, 1952 (Paragraph 34 & 57) and
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking up Employment in any Establishment on which EPF Scheme, 1952 and for EPS, 1995 is applicable)

1. Name of Member (Aadhar Name)

Father's Name Spouse's Name YOUR PERSONAL DETAILS
2. (Please tick whichever applicable)

3. Date of Birth (dd/mm/yyyy)

4. Gender (Male / Female / Transgender)
5. Marital Status ? (Single/Married/Widow/Widower/Divorcee) S.No:7
(a) eMail ID IF ALREADY ENROLLED
6.
(b) Mobile No (Aadhar Registered) WITH PF - OPT AS "YES" -
Whether earlier member of the Employee's Provident Fund IF NOT ENROLLED PF
7. Yes / No
Scheme, 1952 ?
TILL NOW - OPT AS "NO"
Whether earlier member of the Employee's Pension
8. Yes / No
Scheme, 1995 ? S.No:8
Previous Employment details ? (If Yes, 7 & 8 details above) IIF PENSION
a) Universal Account Number (UAN) UAN NUMBER APPLICABLE OPT "YES" ,
b) Previous PF Account Number IF NOT "NO"
9.
c) Date of Exit from previous Employment ? (dd/mm/yyyy)
KINDLY FILL REMAINING FIELDS IN THE
d) Scheme Certificate No (If issued)
RESPECTIVE PLACES
e) Pension Payment Order (PPO) (If issued)
a) International Worker DEFAULT - "Yes
NO"/ No
b) If Yes, state country of origin (name of other country)
10.
c) Passport No.
d) Validity of passport (dd/mm/yyyy) to (dd/mm/yyyy)
KYC Details : (attach self attested copies of following KYC's) Must Enclose Scan copy for the following documents

a) Bank Account No. & IFS Code

11.
b) AADHAR Number
c) Permanent Account Number (PAN), If available

After Sep 2014 earned EPS

First EPF Member First Employment EPF Are you EPF Member If Yes, EPF Amount If Yes, EPS (Pension)
(Pension) Amount Withdrawn
Enrolled Date Wages before 01/09/2014 Withdrawn? Amount Withdrawn?
12. before Join current Employer?

Yes / No Yes / No Yes / No Yes / No

UNDERTAKING
1) Certified that the particulars are true to the best of my knowledge
2) I authorise EPFO to use my Aadhar for verification / authentication / eKYC purpose for service delivery
3) Kindly transfer the fund and service details, if applicable, from the previous PF account as declared above to the present PF account.
(The transfer would be possible only if the identified KYC details approved by previous employer has been verified by present employer using his Digital Signature
4) In case of changes in above details, the same will be intimated to employer at the earliest.

Date :
YOUR SIGNATURE
YOUR D.O.J,
Place : D.O.J Signature of Member
PLACE: CHENNAI
DECLARATION
YOUR NAME BY PRESENT EMPLOYER
A. The member Mr./Ms./Mrs. ……………..…………………….. Has joined on ……………………….and has een alloted PF Number ……….……..

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995: ((Post allotment of UAN) The UAN alloted or the member is)
Please Tick the Appropriate Option : The KYC details of the above member in the JAN database
Have not been uploaded Have been uploaded but not approved Have been uploaded and approved with DSC

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS 1995;
The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate and transfer request has
been generated on portal
As the DSC of establishment are not registered with EPFO, the member has been informed to file physical claim (Form-13) for transfer of funds from his previous
establishment.
DO NOT SIGN
Date : D.O.J Signate of Employer with Seal of Establishment
To,
Date: YOUR NAME
The Manager
Human Resources,
Saipem India Projects Pvt. Ltd.,
MILLENIA BUSINESS PARK PHASE II
CAMPUS 3A - FLOORS 3,4,5,6 & 7
No: 143, Dr.M.G.R Road (North Veeranam Salai)
Kandanchavadi ,Perungudi , Chennai - 600096

NAME : YOUR NAME

STAFF NO. : DO NOT FILL

D.O.J : YOUR D.O.J

Dear Sir,

I request you to kindly arrange to deposit my eligible monthly salary & other related
payments if any to the following bank account:

NAME AS PER BANK WRITE YOUR NAME AS PER BANK RECORDS

RECORDS
YOUR BANK NAME
BANK NAME
FULL BANK A/C UMBER
BANK A/C NO
IFSC CODE
IFSC CODE

Thanking You,

Yours faithfully,

TO BE SIGNED

(Signature)
Future Generali India Insurance Company Ltd., Date: YOUR D.O.J
9th floor, VBC Solitaire, 47 & 49, Bazullah Road,
T Nagar, Chennai – 600017.

Thro’ : Human Resources,

Saipem India Projects Private Ltd., Chennai 600 034.

Dear Sirs,
Group Personal Accident policy – Policy No: FGH-14-19-7001447-02-000 (Sum
assured upto Level 11 Rs.15 lakhs, level 12 to 15 Rs.30 lakhs)

Staff Name Date of Birth Level Sum Assured

No. DD/MM/YY
DO NOT YOUR FULL NAME D.O.B YOUR SUMM ASSURED AS PER YOUR LEVEL
FILL
10/10/06 LEVEL Rs.

Group Medical Insurance Floater policy – Policy No: FGP-14-19-7003526-02-000

(Sum assured Level 2 to 10 Rs.5 lakhs, level 11 to 12 Rs.10 lakhs, level 13 & above Rs.15
lakhs)
Kindly arrange to include self and following of my family members under above mentioned policy
YOUR D.O.J
effective from ________________(DD/MM/YY).
Sl No Members Name Relationship Date of Birth Age
DD/MM/YY
YOUR FULL NAME & YOUR D.O.B &
YOUR
YOUR DEPENDENTS Staff DEPENDENTS
NAMES D.O.B DETAILS
WITH AGE
/ /

Spouse / /

* Child 1– Male/Female / /

* Child 2– Male/Female / /

** Father / /

** Mother / /

Staff wedding date: (DD/MM/YY) / / YOUR WEDDING DATE , IF MARRIED

Staff Signature :

Note:
* Child Age limit should be less than 21 years.
** Parents Age limit should be less than 80 years.