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Self-Declaration Form

(For non-domain laptop)

Date:

Name of the employee: Subhashis Chakraborty


Email ID: Subhashis.c@tataelxsi.co.in
Contact Number: 9123928382
Company Name: TATA Elxsi LTD
Employee ID: 3043630436
Department: PSG
Joining Date: 24/04/2022
State Gujarat
City
LFL Site Type
Details (AG3/SAG2/AG2+OTN/MCN/IDC)
Site SAP ID
Reporting Manager in RJIL:
make and model: Dell
Laptop Serial Number GT75DL3
Ownership Company provided
Installed Yes
Antivirus Name Windows Security
Last updated date 18/04/2023
Operating system Windows 10
Critical Operating System patches: Updated
USB port: Disabled
Purpose to carry laptop inside server Unity storage troubleshooting
room:

The above-mentioned information is true to the best of my knowledge and violation will carry
implications as per Jio Information security policy.

Yours Faithfully,
Subhashis Chakraborty

Date:

Place:

Jio format for Non Domain laptop Internal V 1.0

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