FILE AUDIT CHECKLIST

Central Record
JOINING CHECKLIST Local SPOC
SPOC Room
Document Name Points to be checked Yes/No Yes/No Yes/Pla
Bios Data / CV (Signed by candidate)
2 Personal Data Form Data to be filled Unready
Date of Birth Proof 100 Pars Certificate. Pan
Garth Passport. Driving Licence.DOB
validity of the documents to
certII cate.
checked properly
4 Residence Proof tether Present! PerManent)

5 Photo identity Proof

6 Edu cation Proof
7 Photograph of candidate al 6 photos . passport size
1)) /Sarre 6 Mobile no on back,
of each photo
8 Offer Letter{ Duly acknowledged 11).
candidate) a) to he signed by candidate
9 Statutary forms to be filled 6 signed by
candidate
(Films 1 (MC). RIMS 2 IPF).
Form 11 (EPF). Form I
(Nomination S. Declaration).
Form F OFF yll1Pnt of Gratuttyl
E. Medical Declaration Form
10 Candidate Joining Confirmation Nail
Confirmation from OnCiel
mall ID of client manager
Auto Generated Mail FrOM
ESS Portal
11 Sank Account Declaration sell Declaration Form

Local SPOC signature and ID

Central SPOC signature and ID

Record Room Incharge signature and ID

*KutiMbh care PERSONAL DATA FORM
trr Itutumbh Care net Ltd, A- I3 1.3.71 Unit no. - 702, 7th Floor Highway Towers. Near
layyee University Sector— 62 Noida -201309 (19.)

Phone Number : +91 120 4243783. hel den kutUmbheme cam

eed3/2304 701 5.'""

PERSONAL DETAILS
EMPLOYEE N
EMPLOYEE NAME
Date of Joining
Designation
Blood Group
Father's leMne
Residentml Address Date of Birth
Gender

Mental Oahu

Date Of Marriage

Residence ghee
Mobile
Permanent Address
Height (ans)

Weight (kgs)
PAN No.
D/L No.
Aadhaer Card No,

E mail Address

Emergency Contact Person Name

Emergency Persons Contact No,

FAMILY DETAILS (please mennen defamer remedial:el-Ka, wenn and dependence deny)

ReMPOIISYM with Pending with

Date of Birth Occupation ernplOyee. employee.

Name of Family Member
EXPERIENCE DETAILS (provide details ea lastaaree eAcielVarsal last 5 yearmthioriever loiter)

From To 0 rganitation Last Designation Reason For Leaving CTC (PA)

EDUCATION DETAILS &lease molds the education quarantine details)

Qualification Specialization School/College & Year From To (0 Mar/SS/Grade

Univeroty/Board

VERIFICATION DETAILS (Mose provi&thefollore& detslisfor vedesathsolltslemasyer)

Name of Employ.% Employee ID

Last Designation Phone No.

Address of Employer Data ordaining

Last working Days
Gross salary (PA)
Relieving Done
Reason Inc LeavIng
Supervisor's Name Contact No
HR Manager's Name Contact No

REFERENCES (please en professional Mils al ramIly relations)

Nam Name

Designaho DesIgnatmn

Compan Company

Mobile note °bile number

MEDICAL DETA U.S (a on a or mecbmaan et dlleVPS with earteritsrams)

Period from Period to Nature of Ill ess Remarks

New candidate References (Please refer Job Seeker's details in Maw [endplate)

Candidate Name Contact Number Email ID EtperienCe (In Years)

DECLARATION PHOTOGRAPH

i declare VW the information Oren In this perm's] data row and the certifirater arrOwanying is correct and
complete to best of my knowledge and belief. I also understood that at Ply stags I rnay be asked to provide
adequate09111'031bn of the facts stated above, and I would do on when called for. I accept the job and podrion Aldo digibilooper riavolatie
given to rue in all respects. I authorise the company arid/or I reproventitves to verity the information pont:red Yin rood Poido a soil roger
above and In my resume, and conduct enquiries as the 'eel ploy deems fit I also authorise the company to PoiroarliourPilotigaril
share this Information with it representlives to verify its airlientCity. In Cade the COMpany finds any room*
informkOil false or misleading. I accept the Cornpanys decidon to vididravi the employment off er made to me
un000ditionally.

Place Date Signature

 LUTE(q DECLARATON FORM thstSibeFiensT

cml a-r4 t irter Eilitzfirt anTh-R tR wffig w4NTF67I wPf TR" Inb-4
etc #91 *Cy I cS OTE I

To he ICS by employee alter read bstruction overleaf. Two Postcard Size phlographe to be attached with the
tom The form Is tree of east
mita sefeel ?Cato *Mar
(M)
(A) INSURED PERSON'S PARTICULARS (B) EMPLOYER'S PARTICULARS

AtetrelrienfenCe Na s. PEW El WPM

E ploys? Code ti
2•WaT (aarZ YIXTX) tax far %.1 TYNE XXYff
Nana In alOYX lealera Oala I Apanntnient Day Mush Year
s.firmnfra snrcr
Fathersmusband's Nerna II nallar€ a31 w s XS/Name Address or Be Eno! rat

tUel SST ati s keta PISS&

Date of OM Day Yee snkift
Mantel Roc
StaalS MAJNY Abitt WAISM E B fit Evrtretureletere Titt
al ay:rev/am praoausernalayrampreaae lbeettaHeea wader
.6 OE( Sex
tffittliot inn fivi

(t)MEtra a an
(b)ErnOye6COde Na
RV Cs Pa Os
Ps Ca& kcope 1111 111111 MaaWEmaala YR
M Nava & Ackyreys claw EmpLayar
SebeBE leittfEent ebtehriniTEbientret.
Wren eighty .thenreta
aTaXitxxle atariamall ad&On
Brach Via us Di penny/

a) Dada df Narnaute We 71 of CO AC111140/Rulebe(2)01 Eel (central) Rules. 195eful peewit of azi

anTeNanta areystivoteseeshie *5 55

mtivir irmr 4.P2 Ftp Int MT% ktr efrafnere SEW w(1IS LB Stye anus el epee se BEV" Or Lau
IS f!a* tiff em ma ma Yr4a t tal t4.3
hereby &calve ihal VIA perbeulaisphlen by me teneellethe pew or 9, know! Spa and belief undernani to Intimate Ore colperaLen any
changes In me membership wy family w tmth le days el nth Change

iataaai elbeletnil 4iT laXinft471 ?XVI

fgrfr 4.
I.tl 1P
Counter sienna by the ernes:Vet

*AM Marl
Signaria WWI Beal
*arta" 7010!i 911-491 ma plarrxi

RR gini TA *ere wfira i n9012111 awn-4YMa! ark at a) wars

NIElfl a arnrrAlitill RailataixallipMai Ma 4 P mild aw Itrrr UTI7
Dem ot esuineve ae on STUMP° Marne, residing Ir Ha state Place of
dais of teem Lemma wen hinitiver Real ate
rebut eleittio benbunin SitriSine

PLOY el mite f SUE nts

ESI COrparallari Temporal, I anal/ Card Mild fix 3 feu Lem the date of appointment)

elittaine

tent tierrilne. Na Pelee SS erBersone or apnea-01W

tee B fern
Sur Innen
Blanch Me Dispenses/

f *CT Yr eu foal tr tur

Ernployere cods PO.8 Add

vanity
aWd Rellitulye et Sue am Sr warn *Tx ct WRIT
eitte
Signature or BSI 14111 seal
Dated
 are9r
INSTRUCTIONS

AI fr31 vvxn41. (tilligur) ffikiFir 1750 TM* II a MU4IMMefet- tl aMil E I

Submission of Fomn-I is governed by lepUlalian 11 & 12 of ES1 (General) FregUlatiOns.185I)

ere me* Meer NM ale* err yie# #.5

ale* (I) ere (2) Yee art ors mtl weft et wwm sort a rnot. tri wits m5
tora as rim arm t (t) Dim time WW t, wet 21 wit re, erg arm sift a5. 710 IS) Told *gee err
(4)MIS*********** Male er ewe **Rem LA* Ogre et
*Mire Mr Tim t, (5) am *Le imh# 4 7644. titans nee tSI wit 2 tt eft II int MI
maw means all or any 01 the lolloveing Wee 01 an beep Person namelY4

(I) a spouse OS a ingot10015mM° or adopted Mild dependant upon the I. R: Mit a shed who Is wholly dependant on the

O} a MEM who inlimn by mason of any phytial o mental abnonnality or Slum and is wholly dependant on the earnings
or lie I, P. so k% as the Inflmnity COMInUeS4 (a) dependent parents (Please see Section 2 clause it of the ES! Act 1948 lot

SO** *ISM* M
Iderdlly Corti Is Non-Translatable.

4. Salle =*1 ft:eft ei fetwmaner II* rdi 01#711 REM DM I

Loss at !denary Card be reported to Employer/Branch Manse immediately.

5. Ittsg Ha Mt smer #it t mXLt *am ISM witt-54 * DIM #Ter Ml DT flee I
submission 01 false infomnalion attracts penal action Under Section St of Egleicl. 1048.

6.#1 SL flotIM tri rist gals Yrs otri Pme Rai* two tem Sinell ;salvo la Mer fei
*me toot fest 15 fl iztlat f(twu mutes www tamer MI %1
This form clay filled in nest each the concerned Stanch Office Me 10 days of appointment of an Employee. Delay
Millraces penal action under Section 85 of the AM against em*yer.

7. talle *Si aT# alle 41050.4 lamelteretworms-twOiarwistefeumwst (I)

tyre-Mr (2) ti4L* Stem titerant (5) smelts*, ftem (4) Ynfernwe towns (5) 752ir fROTIM (en mobErlfl WfAryi

Inelude (1)Slokness BenoM(2)Tamporary Disablement bee (3)Perrisanesit dele4rtenlBene111(4)Dependanis benefit

and (2) Metern rN• Benefit (in case of woman •employees) subject 011d011ell 04 COrttnbeifOry OnditiOne,

6. iWstwat t mem fest t elms( t•8! Scrim trolo• an Ne4N1 *Aft • erele4 it
For more del* pee comae website of ESC at maw. *erg in. or ConleCT Pepe:Mal Mtge Or Branch Ogee

Aare SIM atom 15 me *

For Branch Office Use only

1 eta wet wrests ti trim

Dl 1 Itot I fl N •

2 erfeln W62•12 tle• NT(' afe2 egt

Oele Of lasse of T I C

a. taw tor ow

I. Nee areteK (et-a» attar zoners 6? wit V, weft t-5 :

Whether nrciprocal Medical arrangements Involved II yes. plezit tdicafa t

eTINIT lie

me Mr fla gr mew rtre g era Stag eshref2 eleett eft 212. el entim
Name iier semen Relationship ebb the re 7 were ems sofq
(rats S 0flv 5S 00 Entree:TN Whether waidIng. Cr Na. ate Flsce
awe or item item Atm nooses Residence
gnu oftto AlaliTavin
 Form : 2 (Revised)

NOMINATION AND DECLARATION FORM

FOR UNEXEMPTED / EXEMPTED EXIABLISHMEN Pa
Declaration and Nomination Pow under the Emplomoi Provident Funds & Eemployees Pelagian Scheme

(ParaWaPh n & 61(1) of the Employee Provident Raid Schen: 1952 & Paragraph IS orthe Employees'
Pension Scheme. 1995)

I. Name or Employee 6. PE 05/NHP/0939804/

(PA& Mae& AMAMI No.
2. Father's / Husband's 7. Address :
Name
Date (SENO& Age of Temporary

Employee Yeaas

Sex (Mak !Female)

P a tol/
Native Place
Marila/ Mello

8. (a) Date ofjoining or EPP MI armee 1952 1 1

MS Date ofjoining. of Employ ea Family Pension Scheme, 1971
leaDate el/joining of Emeriti ea Gamily Pension Sahara& 1995 / /

PART- A WPM

I hereby nominate Detersoin(s)/ march& riOninabOn madeby nee mammas& and aommate the personnel, mentione4 Mow to anive
the amount seeming to my Dada in the EDTICANS Prnyideal Fund, in Doman OF MY THAI-

Dann& Nonanee Address of Maumee NOMivres Date gain& ann Tcad amouot ot MR' esifluet is° m"r.
RellIELOINSInip ainamme gni/ref none agia reargnmaship
Dth insured accuagalnlons in DT adness dale
Priam proANategad Cu pardon atoms
S paid 1004h ermivelearganni
31miltivx &Any& maw& at
mamma

4 5 6

I. • Cenifird Mal I Imam no family as deFined in pan (9) of the mil lo>ee& Provident Fund SchSie.1951 and should aequim a
family homafter the &Nye nomin lion should be deemed as cancelled.

2. ' Certified thai my father! mother is/ are depandent pon me

0
Signature or Thumbmapression of the Insured Person

strike out whichever is not applicable

 YART41 (EPSI
(Para l8/
I hereby furnish below varticulars oftiso mcmbrs of my family IAD would he cliblt to Id ion i
the mem of my death.

Sr N•mc of Fondly Atemisto Allilmo .ufFmnily Plentren Dote prBirthl Age NOMInee'S tlehtlordhiP
erFC114 Members karred

2 3 4

I." Certinsither I have no family, as dented in pare 2(vill of Me Employees Pension Scheme, 1994 and hould I acquire a
family hereafter I shaft furnish particulars thereon in the above form.

I hereby nominate the following person far the monthly widow pension (admissible nod r pant 16 2(a) C)& (ii) in the event of
my &Mb without 'cooing any eligible family member for receiving pension.

mere a ea me erthe Nem Ince Pair al oinn RthiCionship rite warred pence

Date 1

0
" Strike out whichever is not applicable Signature or Thumb impression of the Insured Person

CERTIFICATE BY EMPLOYER
certified Oral the above declaration and mind:moon too nem signed? rhumb impesued before me by
employ" in cry eftabliShMen alter he Ishe hes read the entries / entries have been reed
over ro him/tor by nrc end SS COnifirmul by him I tun"
For Kutumbh Care hi Ltd.
Place

Date :
Signature of the employer or the authodscd Officers
of the Establishment
Desiisation 1 Director/ Sr. Executive - Staffing

nutumbhCarnPve Ltd, 2161i, Second noon GaUtain

Nagar, Now Delhi 1L0049

Name & Address of the Factory / Establishment or

Rubber Stamp thereof.
 FORM -I

Nomination & Declaration form

See nile 3

I. Name of person making Nomination

2. Father or Husband name
3 Date of Birth
Sex
Martial Status
Permanent address:
Village Thane Sub-division
Post Office District State
I hereby nominate the Person(S) /Cancel the Nomination made by me previously and Nominate person(s)
mentioned below to receive amount due to me from the employer in the event of my death.

Nominee(s)

Name in full with full Relatlo Age Total amount lithe nominee Is minor,
midges of nominee(s) nship of of share of name, relationship and
with no accumulation address of guardian who
the min in credit to be may receive the amount
employ ee pale to each during the minority of
ee Nominee Nominee

(1) (2) (3) (4) (5)

1.

. Cerbfied that' have No family and should I cquire a family hereafter the above Nomination shall be
deemed as Cancelled
. Certified that my father /Mother is /are dependent u on me.
. Strike out the words/paragraphs not applicable
Signature/Thumb-impression of the
Employee

Certificate by the Employer

Cerlified that the above Nomination has been signet /thumb Impression before me by Shriffimt Kum.
employed In my Establishment alter she /he has read
the entry/entries have been read over to him /her by me and got °Minn by him/her

Signature of the employer/Officer authorized Designation

Date.

Name and address of the establishment

Or Rubber stamp thereof.
 Payment of Gratuity (Central) Rules
FORM 'F'
See sub-rule Mal Pule

Nomination

To,
(Give here name or description of the establishment with lull address)

I. shrWShrlmatl/Kumail
(Name in full here)
whose particulars are given In Me statement below, hereby nominate he persons) mentioned below to
receive the gratuity payable after my death as also the gratuily standing to my credit in the event of my death
before that amount has become payable, or having become payable has not been pa id and direct that the
said amount of gratuity shall be paid in proportion indicated against the name(s) of the nomineels).
2. I hereby certify that the person(s) mentioned is/are a member(s) of my family within the meaning of clause
(h) of Section 2 at the Pay men( of Gratuity Act 1972.
S. I hereby declare that I have no family Within the meaning of clause (0) of Section 2 of the said Act.

0 (a) My rather/mother/parents Ware not dependent on me.

(0) My husbands lather/mother/parents [ware not dependent on my husband.
I have excluded illy husband from my family by a notice dated the to
the controlling authority In terms of the proviso to clause (h) of Section 2°f the said Act
Nomination made herein invalidates my previous nomination

Nominee(s)

Name In lull with MI liMilmehlp with Ag0 of Proportion by whIth

address el mmlne800 the emplOyes nemImo Iha gratuity will be
Suomi

MI (2I II) Ai

So
on
 Statement
Name of employee In full
Sex
Religion
Whether unmarriedrmanied/wIdowlwidOwer
DepadmeneBrandeSectIon Where employed
Post he filth TIMM No. or Serial No. if any
Date of appointment
a. Permanora address:
Village Thane Sub-division
Post Office Distri Stale

Place:
Signature/Thumb-Impression Of the
Employee
Date:

Declaration by Witnesses

Nomination signed/thumb-impressed before me

Name In full and full address of witnesses. Signature or Witnesses.

Place'
Date:

Certificate by the Employer

Certified that the particulars of the above nomination have been verified and recorded in this establishmend
Employers Reference No. if any Signature of the employer/Meer colliers's]
Designation

Date' Name and address of the establishment or

rubber stamp !hereof.
 Acknowledgement by the Employee

Received the duplicate wpy of nomination in Form 'Filed by me and duly certified by the employer.

Date Signature of the Employee

Noie.—stake mune not applicable

 Kutumbh Care
i cyfid reio+l
ov‘,

Medical Declaration Form

Personal Dela es
DOB
E Code Name (01)-MNOVITY) Age(Yrs) ELMO ID Contact No

Family Details
DOB
Sr. No. Name (01)-MIVRYYY) AgelYrs) Relation with Employee

Signature of Employee
 i714 Care
*€ Kulurn

Please 1111 this pining repon duly Sugned by Local HR RePresentature I your Supervisor)

JOINING REPORT

Location Emp ID
Date

(Name). an employes of KUILIMIN4 CARE PV)

I

ployee numberstatectabovehave iodnedfor dutytoday.a

tro.lpeen

(please enter office/ project(

location address where reported for duty).

Please treat torn as my first date of attendance.

Since* siunathre of local AuthontY

(Name, Designer:1011)(PR Representative/ Supervisor)

(Signature) (Sioratuful
 Bank Account Detail Format
Date:-

To,

Kutumbh Care Pvt Ltd

Dear Sir,

This is with regard to my employment with Kutumbh Care. I hereby request to please transfer my
monthly salary Into my Bank Account (details given below). I hereby.take full responsibility of
information furnished In this letter & my bank account

Tours Truly

(Signatures)

Name:-

Bank Name:-

Bank Account No:-

Branch Name &Address:-

IBC Code:-

Mobile No.:-

Email ID:-

Enclosure: a) Self attested copy of Bank Passbook/ statement.

b) One cancelled cheque of above mentioned account no.
 www.epfindia.gov.in

Composite Declaration Form -11

(To be retained by the employer for future reference)
EMPLOYEES' PROVIDENT FUND ORGANISATION
Employees' Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking op employment in any establishment on which EPF Scheme, 1952 and /or EPS, 1995 is applicable)

I Name of the member

2
Father's Name D
Spouse's Name
D
3 Date ofBirth: ( DD/ MM I YYYY )

4 Gender: (Male/Femaleffransgender)
5 Marital Status: (Married/U nmarried/W idow/W idower/Divorcee)
(a) Email ID:
6
(b) Mobile No.:
Present employment details:
7 Date of joining in the current establishment (DD/MM/YYYY)

KYC Details: (attach selfattested copies of following KYCs)

a) Bank Account No. :
8 b) IFS Code of the branch:
c) AADHAR Number
d) Permanent Account Number (PAN), if available
Whether earlier a member of Employees' Provident Fund Scheme, Yes/No
9
1952
10 Whether earlier a member of Employees' Pension Scheme, 1995 Yes/No
Previous employment details: (if Yes to 9 AND/OR 10 above I - Un-exempted
Establishment Universal PF Account Date of joining Date of exit Scheme PPONumber Non
Name & Address Account Number (DD/MM/ (DD/MM/ Certificate (if issued) Contributory
Number YYYY) YYYY) No. (if Period
issued (NCP) Days

11

Previous employment details: (if Yes to 9 AND/OR 10 above) - For Exempted Trusts

Name & Address of the Trust UAN Member Date of Date of exit Scheme Non
EPS Ale joining (DD/MM/ Certificate Contributory
Number (DD/MM/ YYYY) No. (if Period (NCP)
YYYY) issued Days
12

a) International Worker: Yes /No

13 b) If yes, state country of origin (India/Name of other country)

c) Passport No.

d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]

 UNDERTAKJNG

I) Certified that the particulars are true to the best of my knowledge.

2) I authorize EPFO to use my Aadhar for verification/authentication/e-KYC purpose for service delivery.
3) Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present P.F.
Account as I am an Aadhar verified employee in my previous PF Accounl *
4) In case of changes in above details, the same will be intimated to employer at the earliesl

Date:
Place: Signature of Member

DECLARATION BY PRESENT EMPLOYER

A. The member Mr/Ms/Mrs ......................................................................... has joined on ......................................... and has been

allotted PF No.......................................................................and UAN ................................................................................................ .

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:
The KYC details of the above member in the UAN database
D Have not been uploaded
D Have been uploaded but not approved
D Have been uploaded and approved with DSC/e-sign.

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:-
0 The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature
Certificate and transfer request has been generated on portal.
D The previous Account of the member is not Aadhar verified and hence physical transfer form shall be initiated.

Date: Signature of Employer with Seal of

Establishment

*Auto transfer of previous PF account would be possible in respect of Aadhar verified employees only. Other employees are requested to
file physical claim (Form-13) for transfer of account from the previous establishment.