tffective Date: 25th Oct'l g AUTHBRIDGE

BuMrt auallTOlfil)d>li

11111
[This checklist is mandatory"
+G3im•Jii/i•l!fo!iMirM/i i•i;IIGi@Ni til\lll\lhli\ll!!l'Jimt!itffll
r a
conducted from th thor c tents Where checks are to be specified for each case or where specific checks need to be
it is Highest L t among the contracted checks e.g. Education Check is mandated but it will depend on the Client whether
!
which can t.a',1 m.o
~s t hor
e any o er or Check Mandated is Highest Education and the candidate has completed 2 educations
category}
Dear Client,

ndI
KIiongYwith
a {v') duly
t(ck the the checks to be verified, Also, ensure that the candidates provide the documents mentioned against the selected check
filled JAF.

Important: Candidate is requested to ensure all documents submitted as proof are Self-Attested stating Date & Purpose. [State
purpos~ as 'employment1, Attestation should be done along the edge of the document ensuring no key areas of the document are
overwntten. This is in your own interest.

Self-attestation ensures your documents are only used for the purpose they are meant for and unauthorized use is dissuaded.

Address Check
Documents Required
Address Previous
Address Current
Address Permanent
Education Check
lQlh
i ,,..
Ration Card/ Passport/ Landline Telephone Bill/ Electricity Bill/ Rent Agreement/ Driving
Licence/ Voter ID Card against each address to be verified.

12th
Diploma
Graduation
Post Graduation
iI~ Mark sheet/ All Semester Mark sheets/ Consolidated Mark sheet/Degree /Diploma/ Certificate
against each education to be Verified.

Employment Check
Current Employment
Number of Previous -121'"
Employments
or Relieving Letter/Appointment Letter /Experience Letter /Last Salary Slip / Resignation Letter
Number of years (to be - against each employment to be Verified.
considered for previous
employments)
Reference Check
Current Professional Reference For Non-Fresher provide minimum 2-3
Previous Professional Reference Professional References from each Employment.
Personal Reference For Personal References: Persons of repute e.g.: Professor, Doctor, Gazetted Officers are valid.

Database Check
Indian Database
Global Database

Criminal Check
Police Verification - Verbal Duly filled and signed CID Form, two Passport Size Photographs and Proof of Address
Police Verification - Written mentioned in the JAF.

Photo ID Check Passport/ Driving Licence/ Voter ID Card/ PAN Card

Passport Check Copy of first two and last two pages of the Passport
PAN Number Check .Gr Copy of the PAN Card
Character Check
GAP Check Same as Documents required for Address (which need to be verified) and Criminal Verification
company Check Provide any valid document on Company Letterhead with company address & contact details
loo'etc.
CV Validation Check t:::l CV of the Candidate

Drug Test
court Room Check
,
Others (Specify)

ARS/BE-Prod/FR/ 43 Ver 1.10 I

Confidential

i
I
Effective Date: 25 th Oct'l 9
1
2

Confidential

ARS/BE-Prod/FR/43 Ver 1.10

 - '. - AUTHBRIOGE
a.-..- •--.,,.sau
BACKGROUND VERIFICATION FORM (to be filled by Candidate)

Y, ere or
(Confidential when filled)
~,,.,,.,.,,..,,.,., . . : '
as
or the details in the BVF should match. Any mismatch of information/ documents or providing false Information may result in
jectlon of your offer/termination of employment and action being taken as per the company policy.

111 portant: Candidate is requested to ensure all documents submitted as proof are Self-Attested stating Date & Purpose. [State
purpose as 'emf?l~y".'ent'). Attestation should be done along the edge of the document ensuring no key areas of the document are
overwritten. This ts m your own interest.

self-attestation ensures your documents are only used for the purpose they are meant for and unauthorized use Is dissuaded.

HOW TO COMPLETE THE FORM

I STEP 1 You may need 15 - 20 minutes to complete the form. . .
STEP 2 Do read all the instructions very carefully. They contain important 1n~ormat1o_
. . .
n about_ how to complete the application in every
· respect and the documents that can be submitted as evidence (the information furnished by you would be incomplete without
documentary proofs).
STEP 3 Fill the form in BLOCK LETTERS with a BLACK ball point pen ONLY.
STEP 4 Sign the "Authorization Release Note" provided at the end.

2. Father's Name
Middle Name
3. Alias Name
First Name Middle Name
4. Date of Birth s. Place of Birth 6. Gender
Town
D Female
[ill CQill 1~1°101\I City \!Z t5Tl\
[91:,ale D Married
D D M M Y Y yy Country : T,"'1V-S:°f'
s. Nationality

9. Contact Details:
STD/ ISO Code Phone(Residence)

Mobile Number: Alternate No.

Mail ID

10. Others
PAN No.(Enclose Copy) E X V p 1R L\ s ri__ .9 c~
Passport No.(Enclose Copy)
SSN/SIN/EIN No. if applicable
I I

number and relevant

11. Are any criminal/civil proceedings pending against you before a cou rt .m India?. If so , give name of court, case
sections of Law.

ARS/BE-Prod/FR/43 Ver 1.l0

Confidential
 Effective Date: 25 th Oct'l 9

n• a false information
. may re
or prov1d1ng .
. n/
·nformat10 r the con,panV. _
documents pohCV•
_ _ _ _ _ _ _ _ __ _ _
y. ere , An mismatch of
I • taken s e -
proof for the details in the BVF ~hould m:!:~loy~ent and action being "
the rejection of your offer/termination ° t applicable, please write "NA ·
lf!ISTRUCTIQNS re mandatory, Wherever no ss verification-
!. Fill in the complete POSTAL Address. All fields o~ the impending visit for_ad9r; the form. foned, Verification would be
2. Keep your family members/ ne!ghbors ~w~ri\e considered as date of s1gn1n 0 n the duration .me__n_•----------=====-.J
3. Duration of stay mentioned as Till Date w t residing at the address 4 . Best Time to visit
4. During verification, if it is validated that you were no
declared as NEGATIVE. 3, Best daY to visit
2. Residence Type Mon -Sat
1. Address Type

0 wned
Hostel/ PG O Rental
Current O Previous

Permanent
0 With Relative
gParental

District
PIN Code

Functional Title
Official Title
Temporary
~manent f~e

0 Agency Part Time No

5. Payroll Company Name

(as stated on salary slip)
t\ IV PUJl\- L -- Of location where you have worked
Of Head Office leave blank if same as head office
Details

Address
{) tt nt<<j) D KA- "'1 o-t"\ flti-A,
141 t"(i.:~H2J-H~-~01>Lf>1Jl2, t< o,m-
Phone Number
6. Deputed to Company
(Leave blank if same as in point 5) Of location where you have worked
Of Head Office
Details leave blank if same as Head office

Address

Phone Number (Board line )

9. Employee 11. CTC 12. Key Responsibility

From Date
dd/mm/ Code Per annum

8. Employment Tenure

Confidential ARS/BE-Prod/FR/43 Ver 1.10

 ~ /y~

ate: 25 th Oct'19 A UTHBRIDGE

(:.., :it""CIJV..J~ . c,o,

a Hostel/ PG/ R
of our Landlord/ Owner/ Warden :
ntry is restricte /RWA Society etc., is
e contacted for veri fication of the add ress provid e

Confidential ARS/BE-Prod/FR/43 Ver 1.10

_J
 \
I
~- I

-
Effective Date.
Please note that AuthB 'd
25th O ,
ct 19 . .
~-~-
AUTHBRIDG\
n behalf of your
employer. Given belowr!s g~ Research S~rv1ces Private Limited will be conducting your employment background_~erl~cati~:uohave right to den
\
and not sign the A th . t e Au th orization letter, where you need to sign to authorize for your background verification.
u °"""'"lette, ;1 you do oot waat to allow fo, ,e,mcauoo. \

'To whom so ever it mav concern'

th
:/utorize e Employer, AuthBridge Research Services Private Limited ("AuthBridge") and its associated third parties (irrespectived of
t o o tam e collect,
cabio~) to
1
process, store, use transfer maintain my Personal data sensitive Personal data (if required for verification) in or er
• . ' ' '
mp oyment verification report in connection to my application for employment

The em~loyment verification report may include information regarding my character, reputation, personal characteristics, Educa!ion
th
(Au_ en~ication of acquired or pursuing Degrees/Diplomas); Employment history; Credit history; court records, including criminal
verification records as permitted by law; National Identity Verification; Drug Test; Finger Print Verification; Address Verification
,references from professional and personal associates as maybe applicable and any other check as found relevant for the profile.

I, further understand and agree that the employment verification report may be obtained at any time and any number of times as
necessary before, during or post my employment.

nd
I u erstand that some or all the information I have provided in this application form will be held as digitized or physical records as per
the data retention period, contractually agreed between the employer and AuthBridge.

I hereby_ authorize my all previous employers, educational institutions, consumer reporting agencies and other persons or enti ties having
information about me to provide such information to the employer, AuthBridge and its associated third parties for the verification
purpose.

I understand that the continuance of the employment or the offer of employment is contingent upon the outcome of the background
check conducted on me.

The proof of Identity enclosed and self-attested for reference. A Photostat, or any other copy, of this instrument bearing my signature
shall be equally legally valid as the original.

Note: 1. It is mandatory to duly sign the form on the space provided below or else the application form would be rejected.

2. If you are an EU (European Union) subject, you have the right to withdraw consent for processing of your Personal Da$fl at any time by
contacting your employer/ organization initiating your Background verification. You also have further rights with respect to your Personal Data
processing, subject to conditions and restrictions set out in the applicable laws. To know more about EU data subject rights please visit
https://ibridge.authbridge.com/home/privacy-policy.

URL - https://ibridqe.authbridge.com/home/privacy-policy

By signing this authorization, you also acknowledge that you have read, understand, and agree with the privacy policy found on our URL.

~"\~XC1
Signature:_
· -=~
= - - - - -- -

Name : ~-J.u k ~Y'MQ.11 yQ_~

Date: 0 2. I{2. / 2. n _1
Place: --iKl'.-+-.lt.~,t:4=\--\- - -

Confid ential ARS/BE -Prod/ FR/43 Ver 1.10