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Employee Declaration Form

The pre-employment declaration for ICICI Home Finance Company requires the applicant, Anas Farooq Parkar, to confirm the truthfulness of their responses regarding any legal issues, past employment with ICICI, and medical fitness. The applicant also declares they do not intend to become a DMA/Connector/Referral Partner and acknowledges that false information may lead to withdrawal of their offer. The document includes authorization for background checks and communication via electronic means.

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6 views1 page

Employee Declaration Form

The pre-employment declaration for ICICI Home Finance Company requires the applicant, Anas Farooq Parkar, to confirm the truthfulness of their responses regarding any legal issues, past employment with ICICI, and medical fitness. The applicant also declares they do not intend to become a DMA/Connector/Referral Partner and acknowledges that false information may lead to withdrawal of their offer. The document includes authorization for background checks and communication via electronic means.

Uploaded by

parkaranas230
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Pre-employment Declaration

I understand that my employment with ICICI Home Finance Company is subject to necessary clearances as deemed fit. I
hereby declare that my responses in this declaration are true and correct to the best of my knowledge and belief.

Sr. Details Yes/No


No.
1 Do you have any Investigation/s, FIR/s, Arrest warrant/s, Litigation/s, Criminal case/s and/or Conviction/s pending
against you either currently or in the past, in India or abroad? No
2 Are you a member of Banned Outfit(s) declared by the Government? No
4 Do you have any investigations/disciplinary proceedings/ suspected or alleged
misconduct related procedures with current/former employer(s) initiated against you? No

If answer to above is “Yes”, please mention further details

Have you worked with an ICICI Group company/companies during your professional tenure? Yes/No.
If “Yes”, please mention Company name and Employee code

Do you have relative/s currently working with ICICI HFC or any ICICI group companies? Yes/No. If
“Yes”, please mention Company name, Employee code, Designation and relationship

Are you medically fit for employment? Yes/No. If “No” please mention further details

I authorize ICICI Home Finance for below:

 To conduct Credit, Anti-money laundering, pre-employment and background verification checks


 To send communication through any electronic mode

Employee Declaration for Non-Empanelment of DMA/Connector/Referral Partner

I Mr. /Ms.
Anas Farooq Parkar confirm and declare that:

1) I do not intend to empanel me or my family members as DMA /Connector / Referral Partner with my current employer i.e ICICI
Home Finance Company Limited.
2) Further, I or any of my family member /relatives, do not hold any DMA / Connector / Referral code with any financial
institution in the market.

I understand that my Candidature/Offer may be liable for withdrawal /revocation at any given time due to below mentioned
reasons. ICICI HFC may take any action as deemed fit without assigning reason and I shall be bound by any such decision.

1. My responses in this declaration are false


2. Unfavorable reference check received from any ICICI group company
3. Information furnished by me in support of my application is false and/or concealed

Applicant Name Anas Farooq Parkar Signature

Contact no
7798039223 Date 26-02-2025

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