B-341, Spaze I-tech Park Sohna Road, Sector 49, Gurgaon

Phone: +91-124-4291995 / E-mail: info@DEWII.in

www.DEWII.in
Gwyneth Information and Technology Pvt. Ltd CIN: U72900DL2011PTC228564
An ISO 9001:2015 and ISO 27001:2013 certified
.

Consent to perform background verification

Disclosure and Release of Information Authorisation
Through this document it is disclosed to me, and I further understand / acknowledge that DEWII.in a unit of
Gwyneth Information and Technology (P) Ltd., an ISO certified professional company (ISO 9001:2015 for quality
and 27001:2013 for data security) will be providing services to perform background verification.

I hereby authorize DEWII, to retrieve necessary information and prepare such background verification report. I
understand that a background verification report may be prepared, summarizing information from personnel files,
educational institutions, government agencies, companies/corporations, and law enforcement agencies at the
international, country, state or district level, relating to my past activities. I authorise these entities to supply any
and all information concerning my background. The information received may include, but is not limited to,
academic, employment, earnings, professional license, litigation, personal history, government watch lists, fraud
databases, credit reports, trace reports, and criminal/civil history records. The report may include information
regarding my character, general reputation, personal characteristics, and mode of living.

I understand that DEWII will use my personal information provided by me, to complete the background
verification. I understand and authorise that some or all of this information about me, may be converted into digital
formats and shared with the employer, ONLY with my due authorisation and may also be transmitted
electronically as needed.

I understand and acknowledge that the report so prepared by DEWII is solely based on the information availed
through various educational institutes, government agencies, companies and law enforcement agencies as per
the information provided by me and nothing more. I fully understand that DEWII does not personally guarantee
or certify my conduct/character or suitability and DEWII shall never be liable for any defect/error in records or
reporting by such organisations and if any such issues become known to me, I shall be bound to instantly inform
DEWII about the same.

I may request a copy of any report that is prepared regarding me. I may also request the nature and substance
of all information about me contained in the files. I understand I have the right to inspect those files with
reasonable notice during regular business hours. DEWII will provide someone to explain the contents of my file.
I understand proper identification will be required and I should direct my request to DEWII, B-341, Spaze I-Tech
Tower Sector-49, Sohna Road, Gurgaon, Haryana, India, or its current address at the time of enquiry.

I authorise DEWII to perform checks and prepare a Background Verification Report about me and I give all
rights to store my records for the purpose of future reference. I hereby authorise that a photocopy of this
authorization be accepted with the same authority as the original; and this authorisation will remain in effect
throughout, unless I withdraw my authorisation in writing.

I understand that DEWII will share my background verification information with respective employer, or any other
person that is duly authorised by me. My information will be kept in adherence with the privacy policies of
DEWII, available at www.DEWII.in or any of its associated branded sites’ privacy policy pages.

Signature or Thumb Impression: ______________________________________

(Left Thumb for Men and Right Thumb for Women) 1
D 7D 0M 8M 2Y 0Y 2Y 1Y

This document is highly confidential and intended solely for the use of DEWII and concerned entities who are authorised to access this information.
Page 1 of 2
 B-341, Spaze I-tech Park Sohna Road, Sector 49, Gurgaon
Phone: +91-124-4291995 / E-mail: info@DEWII.in
www.DEWII.in
Gwyneth Information and Technology Pvt. Ltd CIN: U72900DL2011PTC228564
An ISO 9001:2015 and ISO 27001:2013 certified
.

PLEASE NOTE: Do not provide the following information until you have read and signed the Disclosure and Release of
Information Authorisation on page 1. The information requested below is needed to conduct your background
verification and IS NOT considered part of your application. PLEASE PRINT CLEARLY

Last Name First Name Middle Name Date of Birth

Shamliya Jagadish Naran 0 7D 0M 7M 1Y 9Y 8Y Y1

D
_________________ _________________ ________________

Alias / Nick name(s) _________________ 9990096661

Phone Number ___________________________

I hereby provide the following document’s (true copies of the original) for Identity and address proof (permanent
and current address proof) to perform background verification.

[ ] Aadhaar Card* 664235810313

ID Number _____________________________Date of Issue _________________

[ ] Voter ID Card HPX5603725

ID Number _____________________________Date of Issue _________________

[ ] Driving License ID Number _____________________________State of Issue _________________

[ ] PAN Card BLNPS3119R

ID Number _____________________________Date of Issue _________________

[ ] Passport ID Number _____________________________Date of Issue _________________

[ ] Employee ID card ID Number _____________________________Date of Issue _________________

*Mandatory document

Signature or Thumb Impression: ______________________________________

1
D 7
D M 8
0 M Y2
0 Y2 Y1
Y

(Left Thumb for Men and Right Thumb for Women)

This document is highly confidential and intended solely for the use of DEWII and concerned entities who are authorised to access this information.
Page 2 of 2