OFFER CHECK LIST

NAME: CLIENT
DOJ OFFER ID LOCATION

PLEASE CARRY THE FOLLOWING DOCUMENTS WHILE VISITING MAGNA TO COLLECT THE OFFER LETTER

Copies Of Education Certificates

SL No Nature Of Degree Submission of the docs If not submitting, reason for the delay
1 10th/SSLC/SSC YES NO
2 12th/PUC/Intermediate YES NO
3 Degree, all semister marksheets YES NO
4 Masters, all semister marksheets YES NO
5 Diploma, all semister marksheets YES NO
6 Others please specify YES NO

Copies of Documents related to previous & Current employment.

1 Current company offer letter YES NO
2 Current
Current company
company salary slips
relieving & exp YES NO
3 letter YES NO
Previous company offer YES NO
4 letter/Payslip/Relieving letter NO
Earlier company offer
5 letter/Payslip/Relieving letter YES NO

COPIES OF OTHER DOCUMENTS

1 Passport Copy If any YES NO
2 PAN Card YES NO
3 Proof of Local/Permanent address YES NO
4 6 passport size photographs YES NO

FOR MAGNA HR USE ONLY

SL NO DOCUMENTS DESCRIPTION
1 BG Check form duly signed by the candidate
2 PD Tool/NDA/Deputation letter/LOU/LAR
3 SBI Account Formalities, Completed/Has an account
4 Mediclaim, Opted/Has a policy/Covered under ESI

Name Of Recruiter
Name of HR
Date Signature Of HR
_____________________________________________________________________________________________
MAGNA ID CARD REQUEST FORM

NAME
OFFER ID/EMP ID
Space for
BLOOD GROUP Photograpph
CLIENT NAME
LOCATION
 Magna Infotech Pvt. Ltd.
Paste your
#10-2-289, PLOT NO: 79, SHANTI NAGAR HYDERABAD - 500 028. recent colour
Tel: 040 3068 7140 / 3068 7180 . photograph
www.magna.in (Size 3.5 x 3.5
cm)

EMPLOYEE JOINING FORM

** INDICATES MANDATORY FIELDS

** PERSONAL DETAILS

Name (as it appears on ID proof) Naveen Katti

Gender Male Blood Group o+ve Nationality INDIAN

Date Of Birth (DD - MM --YY) 8th July' 1985 Marital Status Single
Passport No. If Any Driving License No

Mobile No Landline No

Email ID 1

Email ID 2

Fathers Name Sudarshanarao Katii Father's Occupation

If Married, name of spouse

Occupation of spouse

Emergency Contact Person Name

Emergency contact persons contact details

Present Address

Present cont # landline & Mobile

Permanent Address
Permanent Address cont # landline & mobile
 ** EDUCATION RECORDS

Name of the
University (Indicate NATURE
Institution if education is through school or OF Specializa Year of passing
collecge & place tion
correspondense) DEGREE
of study

SSLC/SSC/
MATRICULATION

PUC/10+2/
INTERMEDIATE

GRADUATION

POST GRADUATION

PROFFESSIONAL
COURSE (s)

PROFFESSIONAL
COURSE (s)
 **WORK EXPERIENCE

Please list your employment history starting with most recent position. Include any periods in which you were
not employed and explain what you were doing during that time. Please complete all appropriate items, even
if you have provided us with a resume. All information provided is liable for verification.

EMPLOYER (COMPANY NAME)

COMPANY WEBSITE

EMPLOYEE ID

EMPLOYMENT PERIOD FROM TO

DESIGNATION HELD
REPORTING/HR MANAGER NAME & CONTACT
DETAILS

EXPLAIN THE REASON(S) FOR LEAVING THE JOB

EMPLOYER (COMPANY NAME)

COMPANY WEBSITE

EMPLOYEE ID

EMPLOYMENT PERIOD FROM TO

DESIGNATION HELD
REPORTING/HR MANAGER NAME & CONTACT
DETAILS

EXPLAIN THE REASON(S) FOR LEAVING THE JOB

Please provide details if you have been into contractual employment earlier.

In case there has been any gap in your employment, please specify the period.
 **REFERRENCES

Name three persons, not related to you, who are in a position to evaluate your Employment and Conduct
preferably former reporting managers or people with whom you have worked.

1. NAME TELEPHONE NO E MAIL ID

ADDRESS OCCUPATION RELATIONSHIP WITH YOU

2. NAME TELEPHONE NO E MAIL ID

ADDRESS OCCUPATION RELATIONSHIP WITH YOU

3. NAME TELEPHONE NO E MAIL ID

ADDRESS OCCUPATION RELATIONSHIP WITH YOU

APPLICANT’S STATEMENT

I certify that the information provided by me in this application and resume is complete, true and correct. I
hereby authorize Magna Infotech or its agents / clients to investigate and verify the information contained in
this application and / or resume. I understand that any falsification, misstatements or omission of vital
information by me in connection with this application may disqualify me from employment consideration.

I understand that employment with Magna Infotech is at the mutual consent of the employee and the
Company and is for specified terms and conditions.

I have read and understood the foregoing statements and accept them as conditions of employment.

Name : ________________________ Signature:

_____________________

Location: ______________________ Date:

_____________________
 FORM – 2 Revised
A/C. Group No.
_________

NOMINATION & DECLARATION FORM

FOR UNEXEMPTED/EXEMPTED ESTABLISHMENTS

Declaration and Nomination form under the Employees’ Provident funds & Employees’ pension scheme
[Paragraph 33 & 61(1) of the Employees’ Provident Fund Scheme, 1952 & Paragraph 18 of the Employees’ Pension
Scheme, 1995]

1. Name (in block letters) Naveen Katti

2. Name of the Parent/Spouse: Sudarshanarao Katii

3. Date Of Birth:8th July' 1985

7. Address:
Permanent
0

4. Sex________ Male
7A. Address
Temporary
5. Marital StatusSingle 0

6. PF Account No AP/_______________________ Date of Joining

The Fund

PART - A (EPF)

I hereby nominate the person(s) cancel the nomination made by me previously & nominate the person(s),
mentioned below to receive the amount standing to my credit in the employees’ provident fund, in the event of my
death.

If the nominee is
Total amount of minor, Name &
share of address of the
Name of the Date
Nominee's relationship accumulations in guardian who
Nominee/ Address Of
with the member provident fund to be may receive the
Nominees Birth
paid to each amount during
nominee the minority of
nominee
1 2 3 4 5 6

1.* Certified that I have no family as defined in Para. 2(g) of the employees’ Provident Fund Scheme, 1952 and
should I acquire a family hereafter, the above nomination should be deemed as cancelled.
2. * Certified that my father / mother is / are dependent upon me.

*Strike out whichever is not applicable. Signature or Thumb impression of the

subscriber
 PART-B (EPS) (Para 18)
I hereby furnish below particulars of the members of my family who would be eligible to receive widow /children
Pension in the event of my death.

Name & Address of the Family Member Date Of Relationship with

Sr. No
Name Address Birth Menber
1 2 3 4 5

1. ** Certified that I have no family as defined in Para 2(vii) of the Employees’

5
Pension Scheme, 1995 and should I acquire a family hereafter I shall furnish particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension admissible under Para 16-2(a) (i)
& (ii) in the event of my death without leaving any eligible family member for receiving pension.

Name & Address of the Nominee Date Of Birth Relationship with Member

Date: Signature or Thumb impression of the subscriber

** Strike out whichever is not applicable

CERTIFICATE BY EMPLOYER
Certified that the above declaration has been signed / thumb impressed before me by Shri / Smt. / Kum.
employed in my establishment after he/she has read the entries / entries have been read over to him/her by me
and got confirmed by him/her.

Place: Signature of the employer or other

authorized
Officers of the establishment

Dated: Designation
Name & Address of Factory /
Establishment and
Rubber Stamp thereof.
 The Employees’Provident Funds Scheme. 1952
(Paragraph 34)
FORM 11 AND
The Employees’ Pension Scheme. 1995
(Revised)
Declaration by a person taking up employment in an establishment in which the Employees’ Provident
Fund and Employees’ Pension Scheme enforce.

I____Naveen Katti son/wife/daughter of Shri/Smt Sudarshanarao Katii

(Name)
Do hereby solemnly declare that :

(a) I was employed in M/s 0

___________________________________________________________________________________________________
(Name and full address of the establishment)

And left service Dec-99 period to that, I was employed in_____

__________________
0 from___________________ to_______0

(b) I was member of_________________________________________________________________ Provident Fund

**and also of the Pension Fund Scheme from____ ___________________

to_______
___________________________
** but not
and my account Number(s) was/were____
___________________________/_______________________/____________

(c) I have / have not withdrawn the amount of my provident Fund/Pension Fund.
(d) I have / have not drawn any superannuation benefits in respect of my past service from any employer.
(e) I have / have never been member of any Provident Fund and/or Pension Fund.
(f) I am drawing / not drawing Pension under EPS 95.
(g) I am a holder / not holder of Scheme Certificate.
(h) Scheme certificate surrendered / not surrendered.

Date:______________________________ ___________________________________
Signature or Left hand thumb impression of
the member

(To be filled in by the employer only when the person employed had not already
Been a member of the Employees’ Provident Fund)

Shri/Smt______________________________________________is appointed as_________________________________

(Name of the employee) (Designation)

In M/s_______________________________________________________________________________________________

With effect from______________________________

(Date of appointment)

_____________________________

Date_____________________ Signature of the Employer/Manager

or other authorized officer
**Strike out whichever is not applicable
 EMPLOYEES’ STATE INSURANCE CORPORATION
FORM 1
To be filled in by the employee after reading instructions overleaf. Two Postcard Size photographs are to be
attached with this form. This form is free of cost.
(A) INSURED PERSON’S PARTICULARS (b) EMPLOYER’S PARTICULARS
1.Insurance No Employer's code no
2 Name (in block
Father’s/Husband’s 10. Date of
letters)
Name Naveen Katti appointment
11. Name & Address of the Employer Magna
Sudarshanarao Katii Infotech Pvt Ltd, #5/4-2, SR infotech
Date Of Birth DD - MM - YY Marital Status Single Complex, SG Palya, Thavarekere Main
Road, DR Collecge Post, Bangalore -
8th July' 1985 Sex Male 560100
Present Address 8. Permanent Address
12. In case of any previous employment
please fill up the details as under:-

a) Previous Insurance No
b) Employer's Code No
c) Name & Address of the employer

0 0
Branch Office Dispensary

(C) Details of Nominee u/s 71 of ESI Act 1948/Rule 56(2) of ESI (Central) Rules, 1950 for payment of cash
benefit in the event of death.
Name Relationship Address

I hereby declare that the particulars given by me are correct to the best of my knowledge and belief. I undertake
to intimate the Corporation any changes in the membership of my family within 15 days of such change.

Counter Signature by the employer

Signature/TI, IP
Signature with Seal
(D) FAMILY PARTICULARS OF INSURED PERSON

Relationship Whether residing If No, State place

SL Date Of Birth/Age as on dateof with the with him/her? of residence
No Name filling form employee Yes No Town State
1
2
3
4

ESI Corporation
Temporary Identity Card
Valid for 3 months from the date of appointment

Name
Ins No Date of appointment
Branch Office Dispensary
Employer's Code No & Space for Photograph
Address
Validity:
Dated: Signature/TI of IP Signature of BM with Seal
1. Submission of Form-1 is governed by regulations 11 & 12 of ESI (General) Regulations, 1950. 2.
“Family” means all or any of the following relatives of an Insured Person namely:-

(i) A spouse (ii) a minor legitimate or adopted child dependant upon the I.P;(iii) a child who is wholly dependant
on the earnings of the I.P. and who is (a)receiving education, till he or she attains the age of 21 years (b)an un
married daughter; (iv) a child who is infirm by reason of any physical or mental abnormity or injury and is wholly
dependant on the earnings of the I.P. so long as the infirmity continues; (v) dependant parents (Please see
Section 2 clause 11 of the ESI Act 1948 for details).
3. Identity Card is Non-transferable.

4. Loss of Identity Card be reported to Employer/Branch Manager immediately.

5. Submission of false information attracts penal action under Section 84 of ESI Act, 1948.

6. This form duly filled in must reach the concerned Branch office within 10 days of appointment of an Employee.
Delay attracts penal action under Section 85 of the Act, against employer.

7. As an Insured person you and your dependent family members are entitled to full medical care. The other
benefits in cash include (1) sickness Benefit (2) Temporary Disablement benefit (3) Permanent disablement
Benefit (4) Dependents benefit and (5) Maternity Benefit (incase of women employees subject to fulfillment of
contributory conditions.

8. For more details Please Visit website of ESIC at WWW.esic.nic.in or www.esickar.gov.in contact

Regional office or Branch Office.

___________________________________________________________________________________

FOR BRANCH OFFICE USE ONLY

1. Date of Allotment of Ins. No. _______________________________________________________

2. Date of issue of TIC : _____________________________________________________________

3. Name/ No. of Disp : ______________________________________________________________

4. Whether reciprocal Medical arrangements involved? If yes, please indicate : __________________

Signature of Branch Manager

Whether residing If No, State place

with him/her? of residence
Relationship
SL Date Of Birth/Age as on dateof with the
No Name filling form employee Yes No Town State
1
2
3
4