Please provide complete and correct information.

All fie
Please do not use short forms / abbreviatio

Name (Block letters) - (Name, Father's/Husband's name, Surname)

Joining Date
Employee Code
Job Location
Designation
Department
Reporting Manager (TL)
Reporting HOD
Preferred E-mail address of the user (In case of Creation)

Personal details
Name as on Aadhar Card
Aadhar Card No.
PAN Card No.
Passport No.
Validity of Passport (DD/MM/YY to DD/MM/YY)
IDFC Bank Account Number
If Yes, Please mention the Account number
IFSC Code

Current Address

From (mm/yy)
To (mm/yy)
Prominent Landmark
Landline Number
Mobile Number

Permanent Address

From (mm/yy)
To (mm/yy)
Prominent Landmark
Landline Number
Mobile Number

Blood Group
Mobile number
Personal E-mail address
Date of birth (DD/MM/YYYY)
Gender
Hobbies & Interest
Father's Name
Mother's Name
Marital status
Former Name(s) / Maiden Name (if applicable)  
Spouse' Name
Marriage Anniversary
No. of Children
Children's date of birth

Emergency contact details

Name of person and relationship

Emergency Contact Address

Emergency Contact number

Family details
Relationship
Father
Mother

Academic details (all years / semesters)

Type of degree
 SSC or Equivalent

HSC or Equivalent

Graduation

Post- Graduation

Additional Qualitication
Highest Qualification

Extra Curricular Activities/ Scholarships

Work Experience
Details of Current Employer

Details of Previous Employers

Note: Please add more boxes if required to cover employment period of last 5 years
Please account for any and all gaps in employment during your tenure
From
To
Reason:
Complete Address and Location:

From
To
Reason:
Complete Address and Location:

I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the person(s) ment
standing to my credit in the Employees Provident Fund, in the event of my death

Name of the Nominee(s)

1
Jogendranath Jena
Whether earlier a member of Employee's Provident Fund Scheme,
1952 (Yes/No)
Whether earlier a member of Employee's Pension Fund Scheme,
1955 (Yes/No)

Previous Employement details -

Universal Account Number
Previous PF Account Number
Date of Exit from Previous Employment (DD/MM/YY)
Scheme Certificate No. (if issued)
Pension Payment Order (PFO) No. (if issued)
International Worker (Yes/No)
If Yes, state country of origin (India/ Name of other country)

Are there any civil/criminal cases filed against you or entities controlled by you in any police station? (Yes/No)
 
Are there any civil/criminal cases pending against you or entities controlled by you in any court of law? (Yes/No)
 
Are there any civil/criminal judgments passes against you by any court of law? (Yes/No)
 
Do you have any investment in stock market? (Yes/No)
 
Do you have any pre-existing medical condition or complication? If yes, please specify (Yes/No)
 
 I certify that information provided in the above declaration is true. I understand that false information may be grou

Date
Place
Please provide complete and correct information. All fields are mandatory.
Please do not use short forms / abbreviations.

ANURAG JOGENDRANATH JENA

22nd April 2020

NASHIK
RESEARCH ANALYST

anurag.jena@decimalpointanalytics.com

ANURAG JOGENDRA JENA

20-Dec--3741
BYOPJ9519C

20-Dec--3741
SBIN0000575

Flat No.7, 4th Floor, Almond B2, Sukhwani Campus,

Vallabhnagar, Pimpri, Pune
1-Jun-12
1-Apr-20
Opposite ST Stand, Pimpri

8408888147, 8237126114

Village Pradhanpada, Tehsil Chhatia, District Cuttack

(Odisha)
16-Nov-94
1-Apr-20
Chhatia Jagannath Temple
B+ve
8408888147, 8237126114
anuragjena1994@gmail.com
16-Nov-94
Male
Reading newspapaer, travelling
Shri Jogendranath Jena
Smt Devdatta Jena
Unmarried

Name Date of birth

Jogendranath Jena, Father  

Bank of Maharashtra, Head Office, Shivajinagar, Pune  

7507868750, 7507242224  

Name Age
Jogendranath Jena
Devdatta Jena

University Name and Address College/Institute Name

Class 12th, CBSE Board JCB School, Shimla

Class 10th, CBSE Board JCB School, Shimla

Modern College of Arts, Science

BCOM, SPPU
and Commerce
Dr. D.Y. Patil Institute of
MBA, SPPU
Management and Research

Summer Internship, Pune

Company Name
Position Held & Department
Address (main office and branch where worked)
Telephone
Employment Period (date, month, year)
Employee Code/ Personnel No
From
To
Designation & Department of Reporting Manager
Name of Reporting Manager
Contact No of Reporting Manager
Email ID of Reporting Manager
Whether employment is of permanent or temporary
nature - Permanent/ Temporary
Agency Details (if temporary or contractual)
Remunerations
Reason(s) for Leaving
Can a reference be taken now? Yes / No.
If no, when can it be taken?

Company Name
Position Held & Department
Address (main office and branch where worked)
 Telephone
Employment Period (date, month, year)
Employee Code/ Personnel No
From
To
Designation & Department of Reporting Manager
Name of Reporting Manager
Contact No of Reporting Manager
Email ID of Reporting Manager
Whether employment is of permanent or temporary
nature - Permanent/ Temporary
Agency Details (if temporary or contractual)
Remunerations
Reason(s) for Leaving
Can a reference be taken now? Yes / No.
If no, when can it be taken?

ent period of last 5 years

g your tenure

made by me previously and nominate the person(s) mentioned below to receive the amount
in the event of my death

Nominee's relationship with

Address
the member

2 3
Bank of Maharashtra, HO, Shivajinagar, Pune Father
 No

No

ities controlled by you in any police station? (Yes/No) No

entities controlled by you in any court of law? (Yes/No) No

u by any court of law? (Yes/No) No

No

ication? If yes, please specify (Yes/No) No

on is true. I understand that false information may be grounds for not hiring me or for immediate termination of employment a

4/22/2020
Pune
 Date of Birth Occupation
3-Jun-63 Service
30-Apr-71 Homemaker

From - To
College/Institute Address
(month / year)
Sector 3, New Shimla, Shimla 04/2011 to 06/2012

Sector 3, New Shimla, Shimla 04/2009 to 06/2010

Shivajinagar, Pune 07/2012 to 06 / 2015

Sant Tukaram Nagar, Pimpri,

08/2018 to 06/2019
Pune
 Total Amount or share of
Date of Birth accumulations in Provident Funds
to be paid to each nominee

4 5
6/3/1963
diate termination of employment at any point in the future if I am hired. I authorise the verification of any or all information m
 Program (Full
Percentage / CGPA Time/Part Time) Subject Major
 74.80% Full Time Commerce

60.00% Full Time Science, Maths

70.20% Full Time Commerce

CGPA (8.79) Full Time Finance

If the nominee is minor name ad address of the
guardian who may receive the amount during
the minority of the nominee

6
d. I authorise the verification of any or all information mentioned.
 Roll No./ Name of
Enrollment No. Degree
CBSE

CBSE

SPPU

SPPU