ACADEMIC INTERFACE PROGRAMME

Application form for BITS Pilani M.Tech Degree Program in

Software Systems
Employee Number

319386

Name (in full)

Ipsita Pattanaik

e-mail ID (if using client e-mail)

Ipsita.pattanaik@tcs.com

Contact Mobile Number

8801624453

Date of Birth (as per records)

27.03.1982

Date of Joining in TCS

01.04.2009

Prior Experience

3.4

Number of Projects Completed in TCS

Current Place of Work and Branch

Hyderabad

Base Branch

Hyderabad

Relevant Qualifications and Discipline

(BE / BTech / MSc / MCA)

BE

Percentage of Marks (in two decimals)

78.00

Current ISU

ITIS1-Parent

Current Client / Customer

Agilent

Current Project

Agilent

Immediate Supervisor Employee

Number & Name

Shashidhar Tipparaju - 151317

GL Employee Number & Name

Vinod Durgam - 165433

Are you willing to remain at one of the

three locations mentioned during the
course duration?

Yes

Do you commit to serve the company

for a minimum period of TWO YEARS
on completion of the course?
Yes
(If selected, you will be required to sign
a separate agreement to this effect)
I hereby certify that all the above information are true and to the best of my knowledge and
belief.

Date

SIGNATURE OF THE APPLICANT

I am recommending the associate for the above program and agree that the associate will
stay in India till the course completion.

Date
THE GL

SIGNATURE OF THE SUPERVISOR

Date SIGNATURE OF