Employee code (Mandatory) Tf gic: %y SS . i+} | FORM 2 (Revised) | (For Unexempted /Exempted Establishments) NOMINATION AND DECLARATION FORM {Declaration end Nomination Form under the Employees’ Provident Funds and Employees’ Pension Scheme) (Paragraphs 33 & 61 (t) of the Employees’ Provident Funds Scheme, 1952 and paragraph 18 of the Employees’ Pension Scheme, 1996) Account No. (PFIEPS Number) Address (Residential) + Permanent: «Permanent» m 1 Name (in Block Letters) + ePrefixn «AARNet Middle Namen eat anes 2 Father'siHusband’s Name : «Father_Husband Namer (21. QANWRAST LAL 3 Date of birth : @OBY 20-03. 1945- 4 Sex 2 «sexs 5 Marital Status 2 «Marital Status» Pye c 6 7 d a 0003/4) ‘BankAccountNo> 0322.90 |F a Colona g ead Mirzapun. Temporary: «CurrentAddress» des. Ole) Nominee Details [ = = Percentage of St __Name ofthe Nominee | Relationship harass hee [Po Pukmams —uife. Vindaga Coleg) tear, | I n ue ver | » | | | | | | 3) | | | | 4) oe | i a | | | | L i If the Nominee is a Minor please give the details about the Guardian: Name Address : Place: MIT PZ PPUR Date: [o |} [202] ( a ) ze Signature; Agni Page 1 of 2 eee es: eS ieJoint Declaration by the Applicant and the Hiring Manager Date: Applicant Name: Hiring Manager Name: 1 ARUN Kumag ‘confirm that | am aware about the job profile and all its prerequisites. | also confirm that the distance between my current location and the offered MC / Branch location is ims, ''declare that | do have a / do not have any relative working with L&T Financial Services. lf yes, details of the relative are as follows: Name: Relation: Se eed Department: Location eee a a — ' hereby deciare that all the information furnished above is true to my knowledge. 8y submitting this declaration, you also consent to L&T Financial Services performing a check either internally or through agencies appointed by L&T Financial Services, of your educational / professional credentials, credit history and employment records v Gain Applicant Signature Hiring Manager SignatureDeclaration on COVID-19 Vaccination IMr/ Ms, ARUN bUuMAR declare the foliowing information with respect to COVID-19 vaccination. [Tick whichever is applicable}: © Ihave only taken vaccination dose 1 on (date) © Ihave taken both the vaccination dose 1 & dose 2; final dose was taken by me on (date) © Ihavernot taken vaccination doses because of reason) Vaccin Not Ab. CNA) ‘+ Uhereby dectare that the information furnished above is true, complete and correct to the best of my knowledge and | also hereby confirm and agree to get vaccinated on joining at the earliest. Gs div (Signature) Date: 16\0%4\9621