Personal Details

Personal Information

Salutation First Name Middle Name

Mr. Ashutosh Mukunda

Last Name Date of Birth as per PAN Card Gender

Lande 01/01/1999 Male

Nationality Religion Category

Indian HINDUISM OBC

Blood Group Personal Email ID Mobile Number

AB NEGATIVE (AB-) ashutosh.mbacoapune21@gmail.c 9527185362
om

Are you a fresher PAN Upload PAN

Yes BJSPL5732L

Full Name of Father / Husband Domicile (Enter name of the State where you are residing for
Mukunda Parmeshwarrao Lande minimum 10 years or the State where you were born)
Maharashtra

Kotak Email ID First Name Kotak Email ID Last Name Marital Status
(This is Field required for (This is Field required for Single
Kotak email ID) Kotak email ID)
Ashutosh Lande

Any Name/Surname Change Marriage Certificate/ Gazetted copy as a proof for any
No name/ surname change
Address

All
Same as correspondence
Address Address Line Address
Permanent State City Pincode and ID card will
Type 1 Line 2
address be sent to this
address

Permanent
AT-ANANDWADI PO-CHISTUR Maharashtra Wardha 442202
address

All
Same as correspondence
Current
Permanent AT-ANANDWADI PO-CHISTUR Maharashtra Wardha 442202 and ID card will
address
address be sent to this
address

Are you residing anywhere out of India?

No

Correspondence Address

All correspondence and ID card to

Address Line 1 Address Line 2 State City Pincode
this address

Family Details and Mediclaim Nomination

Name of Family Member Relationship Date of Birth Occupation Add under Mediclaim

SANGITA Mother 07-06-1983 Others

For parents and/or parents-in-law, employee will have to enroll them under voluntary parent policy as per
applicable premium amount to be borne by employee.

As per current mediclaim policy, employee, partner and 2 children (upto age of 25 years) are covered under
mediclaim effective from date of joining for employees at M3 and above grade and from 6 months of date of
joining for employees at M1/M2 grade.

You will have to enroll beneficiaries on the portal of insurance company upon the receipt of intimation through
email.

Academic Details(Begin with highest Academic details and Atleast 3 Qualifications are
Required)
 School / Upload
Degree College / certificate This is My
Month of Year of Subject of University % of
/ Institute or Final Highest
passing passing Specialisation / Board Marks/CGPA
Diploma and year Qualification
Location marksheets

Marotrao Dr
BSC-
wadafale Panjabrao This is My
Bachelor
September 2021 Agriculture college of Deshmukh 8.60 Highest
of
agriculture Krishi Qualification
Science
,yavatmal Vidyapeeth

Employment Details

This is My
Date Date Reason Gross Employee HR HR
Company Job Supervisor Supervisor last
Employed Employed Industry for Annual Code(of Contact Contact
Name Title/Designation Name Mobile No. Employment
From To Leaving Salary candidate) Name Email
Details

Relieving Letter/Resignation Acceptance of Last Employment

Contact Person(In case of Emergency)

Name Address Relationship Mobile Number

SANGITA AT-ANANDWADI PO-CHISTUR TA-ASHTI DI-WARDHA Mother 9552661146

Do you have any of your relatives working with KOTAK Group Companies or its subsidiaries ?
No

Please provide the Below Details

Name of the Relationship with the Name of the Employee Code (If
Position
Person Person Company Available)

Bank Details

Note - Please do not provide Joint account details here (only Single account held in your name is required)

I have KOTAK savings Bank Do you have a Bank Account I do not have have any active
Account singly held in your name with account and would open a new
No any other Bank (in India)? one
Yes

Saving banks accounts details ( Provide bank details if not having existing kotak CRN
) Existing KOTAK Customer Relationship Number (CRN)

Beneficiary Full Name Savings Account Number CRN

Details of personal bank account number other than Kotak Bank

 Beneficiary Full Name Bank Name Savings Account Number IFSC code

ASHUTOSH MUKUNDA LANDE Bank of Maharashtra 60178335573 MAHB0000734

Appointment Letter and Resume/CV

I have received and accepted signed appointment letter from KOTAK

Signed Appointment Letter Resume Upload

Refer a Friend for Employment with KOTAK

Name Mobile Number Email ID Upload CV

 My Nominations

Employees' Provident Fund Organization

Declaration by a person taking up employment in the establishment on which Employees,Provident Fund

Scheme, 1952 And/Or Employees' Pension Scheme, 1995 is Applicable.

Whether earlier a member of the Employees Provident Scheme, 1952?

Whether earlier a member of the Employees Pension Scheme, 1995?

Have you withdrawn the employee provident fund contribution (EPF) from your previous
organisation

Have you withdrawn the employee pension scheme contribution (EPS) from your previous
organisation - EPFO

Disclaimer - If the above information is incorrect \not matching with PF records then you may find difficulty
with transfer or withdrawal of PF & pension in future.

Universal account no(UAN) PF Account Number

Other Details

Place International worker Country of origin

WARDHA No India

Mention the Country Name Passport No Passport valid from

Passport valid to

FORM 2 (REVISED) NOMINATION AND DECLARATION FORM FOR UNEXEMPTED / EXEMPTED

ESTABLISHMENT

PF Nomination
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 Employees' PF, in the event of my death

Part -A(EPF)

Total amount If the

or share of nominee
Nominee's
Name of accumulations is a Address Relationship
relationship Date of
the Address in provident minor of the with the
with the Birth
Nominees fund to be name of guardian minor
member
paid to each the
nominee guardian

AT-ANANDWADI
PO-CHISTUR
SANGITA Mother 07-06-1983 100
TA-ASHTI DI-
WARDHA
Disclaimer - For all nominations data is updated from Family Details and Mediclaim Nomination section

Nomination under pension scheme

I hereby furnish below particular members of my family who would be eligible to receive widow/children pension
in the event of my death

Part-B(EPS)

Name of the Relationship with

Address of the family member Date of Birth
family member member

AT-ANANDWADI PO-CHISTUR TA-ASHTI

SANGITA 07-06-1983 Mother
DI-WARDHA

Disclaimer - For all nominations data is updated from Family Details and Mediclaim Nomination section

Joint Declaration

In the event of Aadhaar mismatch pertaining to Name / DOB/ Gender with Universal Account Number (UAN-
relevant for existing EPFO member) you will be required to make the necessary changes at the EPFO,
alternatively you will need to share your Joint Declaration submitted to EPFO through your current/ last
employer. Click here to Download sample format for Joint Declaration. Your joining will be subject to completion
of this documentation.

Please Attach Joint Declaration (Jpeg , png, docx, Pdf formats are allowed) *

Nomination under Gratuity

Proportion by
Name of the Relationship
Full address of Age of which the
Nominees(s) in with the
Nominees(s) Nominee gratuity will be
full employee
shared

AT-ANANDWADI PO-
SANGITA CHISTUR TA-ASHTI DI- Mother 40 100
WARDHA

Disclaimer- For all nominations data is updated from Family Details and Mediclaim Nomination section

Nomination Under Benefits

Name of family Relationship with the Share to given

Address
member employee out of 100%

AT-ANANDWADI PO-CHISTUR TA-

SANGITA Mother 100
ASHTI DI-WARDHA

Disclaimer- For all nominations data is updated from Family Details and Mediclaim Nomination section
 My Declaration
Code of Conduct

Declaration Content:

● I have read the ‘Code of Conduct’. I ‘Accept and Agree’ to comply with the Code, including its modifications and
updates.
● I will update relevant, true and correct information as required to be disclosed as per this Code, on an annual
basis (April) or upon change in circumstances/ details reported, whichever is earlier.
● I shall also read and abide all other related documents and policies in reference to various clauses defined in
the Code.
● I agree to comply with any conditions and restrictions imposed to manage, mitigate or eliminate any actual,
potential or perceived conflict of interest.
● I understand and agree that failure to observe this Code and such other policies and procedures as may be in
force from time to time, may subject me to disciplinary action.

Code of Conduct Link: https://www.kotak.com/content/dam/Kotak/investor-

relation/governance/Policies/code_of_conduct_employee-2972021.pdf

Acknowledge
I have read and understood the Code of Conduct and agree to comply by the same

Name: Ashutosh Mukunda Lande

Acceptance Date: 04-03-2023

 Trading Code of Conduct

Trading code of conduct -Click here to read Policy

I acknowledge that I have read the Kotak Mahindra Bank Ltd Trading Code of Conduct and understand the
implications in my role as an employee to comply with the principles, policies and laws outlined in the Code,
including any amendments made by Kotak Mahindra Bank Ltd.

Trading Code of Conduct - FAQ’s

If you have the Doubts you can go Through Our FAQ's

Name: Ashutosh Mukunda Lande

Acceptance Date: 04-03-2023

 AGREEMENT TO COMPLY WITH INFORMATION SECURITY GUIDELINES

Each one of us is responsible for ensuring compliance with Kotak’s Information Security Guidelines.

■ The undersigned confirms that he/she Has read the relevant Information Security Acceptable Usage Guidelines
and understands the procedures described therein.
■ Agrees to abide by the guidelines described therein as a condition of continued employment / contract.
■ Will attend the Information Security Induction training which is part of corporate induction program for all new
joiners.
■ Understands that violators of these guidelines are subject to disciplinary measures including termination of
employment / contract.
■ Understands that access to the information systems of the company is a privilege which may be changed or
revoked at the sole discretion of the company.
■ Will promptly report all violations of the information security policies and security incidents of to
aristi@kotak.com

Ashutosh Mukunda Lande 04-03-2023 WARDHA

User's Signature
I have submitted this form online & I am signing the same electronically
Date Location

ASHUTOSH MUKUNDA LANDE

User's name in block capital letter Department
 Declaration and Authorization for Background Verifications

I hereby authorize Kotak Mahindra Group of companies (or a third party agent by the Company) to contact any
former employers as indicated above and carry out all Background checks not restricted to education and
employment deemed appropriate through this selection procedure. I authorize former employers, agencies,
educational institution etc. to release any information pertaining to my employment / education and I release
them from any liablity in doing so.
I hereby declare that all the details furnished by me in this joining kit (incl. nominee details) and in all documents
submitted by me during the process of hiring, are true and correct to the best of my knowledge and belief. I am
fully aware and understand that the Company is entitled to cancel my candidature and / or withdraw any
employment offer made to me at any stage during the selection and offer process and / or terminate my
employment in event any information furnished by me is found to be false/misleading or incorrect in any manner
whatsoever, at the sole discretion of the Company.

Please note that AuthBridge will be conducting your employment background verification on behalf of your
employer. Given below is the Authorization letter, where you need to sign to authorize for your background
verification. You have right to deny and not sign the Authorization letter if you do not want to allow for
verification. You are also required to go through our Privacy Policy on

https://ibridge.authbridge.com/home/privacy-policy

AUTHORIZATION NOTE

‘To whom so ever it may concern’

I authorize the Employer, AuthBridge and its associated third parties to collect, process, store, use, transfer,
maintain my Personal data, sensitive Personal data (if required for verification) in order to obtain
employment verification report in connection to my application for employment.

The employment verification report may include information regarding my character, reputation, personal
characteristics, Education (Authentication of acquired or pursuing Degrees/Diplomas); Employment history;
Credit history; court records, including criminal verification records as permitted by law; National Identity
Verification; Drug Test; Finger Print Verification; Address Verification ,references from professional and
personal associates as maybe applicable and any other check as found relevant for the profile.

I, further understand and agree that the employment verification report may be obtained at any time and
any number of times as necessary before, during or post my employment.

I understand that some or all the information I have provided in this application form will be held as digitized
or physical records as per the data retention period, contractually agreed between the employer and
AuthBridge.

I hereby authorize my all previous employers, educational institutions, consumer reporting agencies and
other persons or entities having information about me to provide such information to the employer,
AuthBridge and its associated third parties for the verification purpose.

I understand that the continuance of the employment or the offer of employment is contingent upon the
outcome of the background check conducted on me.

The proof of Identity enclosed and self-attested for reference. A Photostat, or any other copy, of this
instrument bearing my signature shall be equally legally valid as the original.

Note: 1. It is mandatory to duly sign the form on the space provided below or else the application
form would be rejected.

1. If you are an EU (European Union) subject, you have the right to withdraw consent for processing of
your Personal Data at any time by contacting your employer/ organization initiating your Background
verification. You also have further rights with respect to your Personal Data processing, subject to
conditions and restrictions set out in the applicable laws. To know more about EU data subject rights
please visit https://ibridge.authbridge.com/home/privacy-policy

I have read and understood the Declaration and Authorization for Background Verifications and agree to
comply by the same.

Signature:
I have submitted this form online & I am signing the same electronically
Ashutosh Mukunda Lande

Name & DOB Ashutosh Mukunda Lande

Date: 04-03-2023
Place WARDHA
 Self Medical Declaration

Medical Report (Applicable for Are you fit for work? Details of the Treatment
Kotak Pvt Bank & KMTSL only) Yes

Are you Specially Abled? If yes, select the category

No

KYC Details

You are requested to submit a scanned copy of your Aadhaar card (both sides) with your Onboarding Reviewer on
email id for the purpose of verification/ generation of UAN (PF Account)

I hereby authorize Kotak to use my details (Name, DOB, gender) as per Aadhaar for my future employment in
Kotak. I understand that all my relevant details will get updated in the Onboarding form accordingly.
 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)

1 Name of the member Ashutosh Mukunda Lande

Father's Name /
2 Mukunda Parmeshwarrao Lande
Spouse's Name
3 Date of Birth: ( DD/ MM/ YYYY ) 01/01/1999
4 Gender: (Male/Female/transgender) Male
5 Marital Status: (Married/Unmarried/Widow/Widower/Divorcee) Single
1. Email ID: ashutosh.mbacoapune21@gmail.com
6
2. Mobile No.: 9527185362
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. : 60178335573
8 b) IFSC Code of the branch: MAHB0000734
c) AADHAR Number
d) Permanent Account Number (PAN), if available BJSPL5732L
Whether earlier a member of Employees' Provident Fund
9
Scheme, 1952
Whether earlier a member of Employees' Pension Scheme,
10
1995
Previous employment details: (if Yes to 9 AND/OR 10 above I - Un-exempted
Scheme PPO NON
Universal PF
Establishment Date of joining Date of exit Certificate Number Contributory
11 Name & Address Account Account
(DD/MM/YYYY) (DD/MM/YYYY) No. (if Period (NCP)
Number Number
(if issued) issued) Days

Previous employment details: (if Yes to 9 AND/OR 10 above) - For Exempted Trust
Name &
Member EPS Date of joining Date of exit Scheme Certificate NON Contributory
12 Address of the UAN A/c Number (DD/MM/YYYY) (DD/MM/YYYY) No. (if issued) Period (NCP) Days
Trust

a) International Worker: No
b) If yes, state country of origin (India/Name of other country) India
13
c) Passport No.
d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]
 UNDERTAKING

1. 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 Account *
4. In case of changes in above details, the s ame will be intimated to employer at the earliest

Ashutosh Mukunda Lande

Date: 04-03-2023
Signature of Member
Place: WARDHA I have submitted this form online & I am signing the same electronically

DECLARATION BY PRESENT EMPLOYER

A. The member Mr. Ashutosh Mukunda Lande has joined on 09-03-2023 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
■Have not been uploaded
■Have been uploaded but not approved
■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:-
■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.
■The previous Account of the member is not Aadhar verified and hence physical transfer form shall be
initiated.

Date: 04-03-2023
Signature of Emloyer 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.
FORM 2 (REVISED)

NOMINATION AND DECLARATION FORM FOR UNEXEMPTED / EXEMPTED ESTABLISHMENT For Office use only
Declaration and Nomination Form under the Employee's Inward No:
Provident Fund & Employee's Pension scheme Group No.:
(Paragraph 33 & 61(1) of the Employees' Provident Fund Scheme, Office At.:
1952 & paragraph 18 of the Employees' Pension Scheme, 1995)

1. Name (In Block Letters) Ashutosh Mukunda Lande

2. Father's/ Husband's Name Mukunda Parmeshwarrao Lande
3. Date of Birth 01/01/1999 4. Sex Male
5. Marital Status Single 6. Account No
7. Address
Permanent AT-ANANDWADI PO-CHISTUR Maharashtra Wardha 442202
Temporary AT-ANANDWADI PO-CHISTUR Maharashtra Wardha 442202 Same as Permanent address All
correspondence and ID card will be sent to this address

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 Employees' PF, in the event of my death

If the nominee is a
minor, name &
Total amount or
Nominee's relationship &
Name of share of accumula-
relationship Date of address of the
the Address tions in Provident
with the Birth guardian who may
Nominees Fund to be paid to
member receive the amount
each nominee
during the minority
of nominee
1 2 3 4 5 6
AT-ANANDWADI
SANGITA PO-CHISTUR TA- Mother 1983-06-07 100
ASHTI DI-WARDHA

1. * Certified that I have no family as denied in para2(g) of the Employee's Provident fund Scheme ,1952 and
should I acquire a family hereafter the above nomination should be deemed as cancalled.
2. * Certified that my father / mother is / are dependent upon me.

Ashutosh Mukunda Lande

2 Signature or thumb impression
* Strike out which ever is not applicable of the subscriber
I have submitted this form online & I am signing the same electronically
(PTO)
 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 Relationship with

Sr . No. Name Address Date of Birth member
1 2 3 4 5
AT-ANANDWADI PO-CHISTUR TA-ASHTI DI-
1 SANGITA 1983-06-07 Mother
WARDHA

* Certified that I have no family, as defined in para 2 (vii) of the Employees' Pension Scheme, 1995 & 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 the member
1 2 3

Date : 04-03-2023

Ashutosh Mukunda Lande

3 Signature of thumb
* Strike out whichever is not applicable
impression of the subscriber
I have submitted this form online & I am signing the same electronically

CERTIFICATE BY EMPLOYER

Certified that the above declaration & nomination has been signed/ thumb impressed before me by Shri/ Smt.
Kum Ashutosh Mukunda Lande employed in my establishment after he / she has read the entries / entries
have been read over to him / her by me & got confirmed by him / her.

Signature of the employer or other Authorised Officer of the establishment

Designation :
Place :WARDHA
Name & Address of the Factory/
Establishment or Rubber Stamp thereof .
 THE PAYMENT OF GRATUITY ACT 1972

FORM 'F'
[See Sub-rule (1) of Rule 6]

Nomination

To,
Kotak Mahindra Bank Ltd,
27 BKC, C 27, G Block, Bandra-Kurla Complex, Bandra (East) Mumbai 400 051

1. I, Shri/Shrimati/Kumari Ashutosh Mukunda Lande

(Name in full here)
whose particulars are given in the statement below, hereby nominate the person(s) mentioned below to
receive the gratuity payable after my death as also the gratuity standing to my credit in the event of my
death before that amount has become payable, or having become payable has not been paid and direct
that the said amount of gratuity shall be paid in proportion indicated against the name(s) of the
nominee(s).
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 of the Payment of Gratuity Act, 1972.
3. I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the said Act.
4. (a) My father/mother/parents is/are not dependent on me.
(b) My husband's father/mother/parents is/are not dependent on my husband.
5. I have excluded my husband from my family by a notice dated the ________________________ to the
controlling authority in terms of the proviso to clause (h) of Section 2 of the said Act.
6. Nomination made herein invalidates my previous nomination.

Nominee(s)

Proportion by which
Name in full with full Relationship with Age of
the gratuity will be
address of nominee(s) the employee nominee
shared
(1) (2) (3) (4)
SANGITA,AT-ANANDWADI PO-CHISTUR TA-ASHTI DI-
1 Mother 40 100
WARDHA
 Statement
1. Name of employee in full - Ashutosh Mukunda Lande
2. Sex - Male 3. Religion - HINDUISM
4. Whether unmarried/married/widow/widower - Single
5. Department / Branch / Section where employed -
6. Post held with Ticket, or Serial No. if any - 7. Date of appointment -

Village : Thana : Subdivision :

Post Office : District : State:
ADDRESS
AT-ANANDWADI PO-CHISTUR Maharashtra Wardha 442202

Ashutosh Mukunda Lande

Place : WARDHA
Signature or thumb impression of the Employee
Date : 04-03-2023 I have submitted this form online & I am signing the same electronically

Declaration by Witnesses

Nomination signed/thumb-impressed before me

Name in full and address of witness Signature of witnesses
1. 1.
2. 2.
Place : WARDHA Date : 04-03-2023

Certificate by the Employer

Certified that the particulars of the above nomination have been verified and recorded in this
establishment.Employer's Reference No., if any_____________________

Name and address of the establishment or

rubber stamp thereof

Signature of the employer/officer

authorised

Date : 04-03-2023 Designation :

Acknowledgement by the Employee

Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.

Ashutosh Mukunda Lande

Date : 04-03-2023 Signature of the Employee
I have submitted this form online & I am signing the same electronically