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Kindly fill up this form and submit the same at the time of joining ‘TCS along with the requested documents mentioned in page 4. BACKGROUND CHECK FORM ‘Name of the candidate (Full): Shaily Ajay Mehta Date of Birth: 24/0/4432 Marital Status : Single / Matfed —————_- Father’s Name : Ajay Mebta Nationality :_Tndian TCS Employee No: 243134 Designation: T-T: Anasuct Place of Joining: Abroedabad Date of Joining : 2/(02{200g TCS Recruitment Branch : Ahrnedabad Present Address (Please note that you should have resided at the current address for at least one month, If not, please mention the immediate mo address where you have resided for more than a month) HHRS/L, 24 Floor, Fb eacss, Fb Main, kaishnaRaju Layout, Venkatadbiai Cay out ,T-P Nagan- Fk Phase, Bangblone - Stoo Period of stay : From: Dee'44 To PhNo: ~ Mobile: SEG 0043 43 Email: Shaily 24-1 @ Qmail-com Address of longest stay in the last Seven years (if other than the Present Address) = D-20%, Subirti Gaaden, Opp. Amarakadamb Bungalows NR Super Society, Satellite Road, Abmedabad- Seo0o1c Period of stay : From: Feb! og To: _Nov'4y PhNo: 0F9- 26926434 Mobile: 9949220048 /9949S44230 Permanent Address: Gare a5 above-addaecs of longest stay Period of stay : From: Feb'0% To: Nov! PhNo: 044-269 26439 Mobile: AQF Strootg | 99F4ISI4230 TCS Confidential 1 Qualifications: Degree | Examination | Specialisat From | To | Yrof | % of marks Passed (ie, | ion OR | OR Roll | Address & Office | (mm/ | (mm/| passin | —& Class! BE,ME ete) | Main | No. | Landline Tel, Nos. | yy) | yy) | eg Grade Subjects i obtained Highest Mesten coz. |Suarak lao Degree oF Komp Sock, Seciaty Tnatibodyct ie Lath ay Corpretaa | of comes Reng Aug, OF Dictinckion | Appticakiog ee Uae aeaden Laoot Bachelor, IRooa- |L-T-Colt : | Qualifcatio [gp oytte of compilacs| aad facth|2003 [qoz, n before the | Cormpudsen| Computes Sanawd-Soabbe uo, |Tu, 7 ae mp 3] Distinct Highest ‘Applicadong Cincies SG High\2000 | Roe: Degree FP Abriedabad | . lot 9 - 29094383 | Previous Employment Details : Period Designation & | Supervisor Name | Employer Name, | Last Dawn | Reasons for Emp No. & Contact Nos. Address & | Salary leaving previous Contact Nos. | (Annual | service Gross) From To _team/yy)_| (am/yy A) Is any case pending against you in any court of Law at the time of filling up this Background Check Form? (fes/ Np) TCS Confidential 2 B) Is any case pending against you in any University or any other educational authority / institution at the time of filling up this Background Check Form ? fex/ Noy €) Ifthe answer to any of the above mentioned questions is Yes? give full particulars of the case /arrest / detention / fine / convietion / sentence / punishment etc. And / of the nature of the case pending in the Court / University / Educational Authority ete.,at the time of filling up this form, NA Reference Details : have either worked or have received Reference 1 Reference 2 Ms-Khanjan Fate! Ma. Paarmid Dave Reference Name & Full Address | A - SH, Pancharnauk. Apaat} E° “fot Sidd hidade- 4 (Other than relatives with whom you |ent, net an Bose ele las paeeers Nehaw Foundation, 2g Be. edakcdev professional education) Kkudasan cand! bpycagan= Contact Numbers Tel: = Mobile: 4924:07429 59 Tel: = Mobile : F@St4o0 4A Designation of Reference TT. Analyst. LT: Anolyst Period for which he/ she knows the ‘ 'S Yas. candidate 4 ‘ps ts Yas Coll Con) Relation with the candidate ecacticliao . oNeo-Que- Passport Details : i) Passport No > Hgoto49t )) Date & Place of Issue 04 (40/2009 , Ahmedabad i) Place & Designation of) Ahmadabad » SuUperint issuing authority iv) Valid upto 0% [to/ROLY I certify that the information furnished above is correct and complete to the best of my knowledge and belief. Date $/02/ 2016 Pace Bangalore. — signature of Candidate SA Mehta TCS Confidential formation TCS application form initially. furnished by you in the Please attach the following documents along with this ‘Background Check Form? :- (a) Two photographs (b) Copy of Highest Degree certificate (c) Copy of Highest Degree last semester marksheet (d) Copy of Experience certificates (e) Copy of Identity Proof (Copy of Passport or Voter's ID card) (). Ration Card copy Date of Initiation of BGC (Date when ‘BGC Form’ is given to the agency) : 1. Name of the HR person initiating the BGC : Signature : 2. Name of the BGC agency representative : Signature : Date of submission of BGC final report to TCS HR by agency: 1. Name of the TCS HR person collecting the BGC report : Signature : 2. Name of the BGC agency representative : Signature : Office Seal of the BGC ageney : TCS Confidential Kindly ensure consistency wi formation furnished by you in the TCS application form initially.

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