MIS REPORT

1 Name of the candidate Vaibhav Sharma

2 Father / Husband’s Name Praveen Sharma

3 Gender Male

4 Date of Birth 31 December 1998

5 Mobile no. / E-Mail ID 9166810958 vaibhavsharma216@gmail.com

Alternate Mobile No. of family

6 9828435693 Relation: Mother
members

7 Marital Status Unmarried

8 Permanent Address 20 Mansinghpura Kisan Marg tonk Rd Jaipur

9 Present Mailing Address 20 Mansinghpura kisan Marg tonk Rd Jaipur

10 PAN / AADHAR No (Mandatory) HTDPS6186J 355541296232

Are you a member of EPF / ESI

11 No
If so, specify

12 Qualification B. Tech

13 Nationality Indian

14 Religion Hindu

15 Caste Bhramin

16 Category (Please Tick) SC ST BC MBC OBC GENERAL ✔

Intern at HIIT Jaipur

17 Experience in Brief

Details of Family members (Father, Mother, Spouse and Children)

18 Nature of Income Contact

Name Relationship D.O.B
Job/Business (Per Month) Number
Rajasthan
Government
Deputy
Praveen Sharma Father 4/7/1968 2L 978392134
Director
Medical
Department
20/10/197 Kendriya
Namita Sharma Mother 1L 982843569
4 Vidhyalay TGT
 Spouse
Son /
daughter
Son /
daughter

19 Languages Known
English/ Hindi
20 Blood Group A+

Details of current / past

21 None
association if any, with STAR
Details of relatives working /
worked in STAR as Employee, Mukesh Sharma
22
Agents, Hospital, Vendors,
Partner, etc.
Details of relatives working /
23 worked in Health Insurance/
None
TPA/other Insurance companies
Have you /are you currently
No
24 facing any criminal
case/convicted by any court?
Are you facing any specific
25 No
health issues?
26 Are you differently-abled? NO ✔ YES If yes, please provide disability certificate
Have you been engaged in any
employment-related disputes,
27 legal actions, or faced any None
disciplinary action (from last 2
employers)?

Are you currently involved in any

other employment or part-time
28 employment activities or holding None
a position in any company,
regardless of its nature?

Declaration: By signing this form, I acknowledge that all the information provided by me, is true and accurate to the
best of my knowledge. I understand that any false statements or omissions may result in disciplinary action, up to and
including termination of employment. I authorize the company to verify the information provided and conduct
necessary background checks, including but not limited to employment history, educational qualifications, and
references. I also consent to the company retaining and processing my personal data in accordance with applicable
privacy laws for the purposes of employment-related matters. The company reserves the right to pull relevant details
from the CKYC (Central Know Your Customer) portal, CIBIL or for any other verification purposes using the PAN,
Aadhaar or any other details/documents submitted by the employee.

Place: Jaipur (Rajasthan) Date: 26 FEB 2024

Signature of the candidate Vaibhav