EMPLOYMENT AUTHORIZATION ATTESTATION

EMPLOYEE INFORMATION
Last Name (Family Name) First Name (Given Name) M.I.

Billakanti Prasuna
Citizenship/ Immigration Status Country of Citizenship Secondary Country of Citizenship
(If applicable)

Last 5 SSN E-Verify Case VERIFICATION # (optional) E-Verify Case DATE COMPLETED

Employer Legal Name Employer authorized representative name Employment Date of Start
(Optional)

As a representative of ___________________________________________________________,
(Employer – Legal company name)
I, _____________________________________________ (authorized representative), verify
that the employee listed above has completed a Form I-9; signed as on _______________ (date).
I am authorized by my employer to perform this task and understand that if I fail to comply with,
make false representations regarding, or attempt to circumvent any of the I-9 requirements,
there may be legal consequences for me and my employer.

As the ‘Sub-Contractor’ to Prodapt (if not the Employer of the Employee listed above); I,
_________________________________________________
Shikha Sinha (authorized representative), certify
that my sub-supplier (Employer of the employee listed above) has performed the I-9 verification
and understand that if my sub-supplier fails to comply with, make false representations
regarding, or attempt to circumvent any of the I-9 requirements, there may be legal
consequences for me and my employer.

By signing this Attestation, the Sub-Contractor & Employer hereby;

(i) Certify that it has read this Attestation and applied a valid, legal signature,
(ii) Confirm that the Employer has completed the Form I-9 for the employee listed above, and
(iii) Confirm that the Employer has received confirmation from the government that the
employee is authorized to work legally in the United States.

By affixing my signature below, I hereby attest that this is true, complete, and accurate.

Signature of Authorized Representative Name of Authorized Representative Date (mm/dd/yyyy)

Employer: ________________________ __ _____________________________ ________________

Shikha
Sub-Contractor: _______________ Shikha Sinha ___________
___________________ 06/19/2020
Prodapt North America, INC. T: 503.636.3737
7565 SW Mohawk St. Bldg. M F: 503.885.0850
Tualatin, OR 97062 USA WWW.prodapt.com
Revised template: Aug 2019