Tube Investment of India Ltd.

Application Form
Position applied for : DEPUTY MANAGER

Name in Full(As per Aadhar):

DONEE MOHANRAJ
(Name followed by Surname)
Affix
Date of Birth : 15.11.1993 Place of Birth KARAIKAL
Passport Size
Sex : Male / Female MALE Photograph
Marital Status : MARRIED Others -Specify

Married Nationality : INDIAN Domicile State PUDUCHERRY

Unmarrie Religion CHRISTIAN

Present Address 6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

Permanent Address 23/3,ANNA NAGAR,PUDUCHERRY-605008

A+
O+ City : PUDUCHERRY
B+ State : Pin code : 605008
AB+ Contact Mobile 1 9940634155 Landline NIL
A- E-Mail : TONYIMMAN0615@GMAIL.COM
O- Primary Medical Details Blood Group A- Height in (cm) 170 Weight in (Kg) 87
B- Mother Tongue : TAMIL
AB- PAN BTDPD6049M Aadhar 575068979161
ID Proof
Voter ID NOG0046888 Driving License
Passport No. : Name in Passport Valid Till
UAN: #FMT
PHYSICAL DISABILITY (IF ANY) No If Yes, mention

Hobbies / Extracurricular
Cricket
activities

Language Proficiency
S.no Language Known Read Write Speak
1 Tamil YES NO YES
2 English YES YES YES
3 Hindi YES YES YES

Family details :
Sl No Relationship Name DOB Sex Qualification Occupation
1 Father MOHANRAJ D 30.04.1959 Male BA EX ARMY
2 Mother LOURDE MARIE M 03.07.1966 Female PUC -
3 Spouse JACCINTHA MARY JP 08.09.1996 Female M.Sc Software
4 Child 1 JONATHAN D 02.08.2021 Male - -
5 Child 2 - - - - -
6 Brother FREDDY 22.09.1989 Male M.Sc Medical
7 Sister - - - - -

Education Qualification:
Full time
S.No Course (highest to Lowest) Institution From To Specilization
/Part time
1 B tech PONDICHERRY ENGINEERING COLLEGE 2011 2015 FULL TIME EEE
2 HSC SEVENTH DAY ADVENTIST 2010 2011 FULL TIME MATH/CHEM/PHY
3 SSLC KENDRIYA VIDYLAYA 2008 2009 FULL TIME MATH/SCIENCE
4

Projects/Training/Apprenticeship, if any

Institution/Organization &
Duration From (MM/YY) To (MM/YY) Area/Topic Covered Other Remark, if any
Location

6 MONTHS Dec-15 May-16 SMEC PGDA INDUSTRIAL AUTOMATION

 Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 1 Name SITRA INFOTECH PVT LTD Employee ID SIL132

From (mm/yy) 12.11.2015 To (mm/yy) 29.12.2019

7-2-1813/5/A, adj. Post Office, Cooperative Industrial Estate, Sanath Nagar, Hyderabad, Telangana
Address Phone Number 040 2380 2131
500018

City HYDERABAD State Telangana

Country INDIA Postal Code 500018

Job Title DESIGNING Department PROJECTS Reason of Leaving PERSONAL
Designation PLC SCADA ENGINEER Annual CTC 400000 Gross Salary 28000
DESIGNING &
Nature of Work HR Manager Name DEEPIKA
COMMISSIONING

Type of Industry HR Manager Phone Number 9074612355

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 2 Name PREIPOLAR ENGINEERING PVT LTD Employee ID PREI4032

From (mm/yy) 24.01.2020 To (mm/yy) 26.12.2021

Address SIPCOT HI Tech SEZ, M -17, Sriperambadur, Sunguvarchatram, Tamil Nadu 602105 Phone Number 044 3083 4012

City State
CHENNAI Tamil Nadu

Country INDIA Postal Code 602105

Job Title DESIGNING Department AUTOMATION Reason of Leaving PERSONAL
Designation SENIOR ENGINEER Annual CTC 650000 Gross Salary 46000
DESIGNING &
Nature of Work HR Manager Name ANBU RAJ
COMMISSIONING

Type of Industry HR Manager Phone Number 8754915432

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 3 Name SCHNEIDER ELECTRIC SYSTEMS INDIA PVT LTD Employee ID 10789653

From (mm/yy) 27.12.2021 To (mm/yy) 25.05.2024

TAMARAI TECH PARK, Tamarai Tech Park, SP Plot No 16-19 & 20A, Thiru Vi Ka Industrial Estate,
Address Phone Number 044 2243 0165
Inner Ring Road, Guindy, Chennai, Tamil Nadu – 600 032, India.

City State
CHENNAI Tamil Nadu

Country INDIA Postal Code 600023

Job Title DESIGNING Department PROJECTS Reason of Leaving PERSONAL
Designation DEPUTY MANAGER Annual CTC 1,020,000 Gross Salary 78000
DESIGNING &
Nature of Work HR Manager Name SHARDA T
COMMISSIONING

Type of Industry HR Manager Phone Number 9486648043

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 4 Name Employee ID

From (mm/yy) To (mm/yy)

Address Phone Number

City State

Country Postal Code

Job Title Department Reason of Leaving
Designation Annual CTC Gross Salary
Nature of Work HR Manager Name

Type of Industry HR Manager Phone Number

 Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 5 Name Employee ID

From (mm/yy) To (mm/yy)

Address Phone Number

City State

Country Postal Code

Job Title Department Reason of Leaving
Designation Annual CTC Gross Salary
Nature of Work HR Manager Name

Type of Industry HR Manager Phone Number

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 6 Name Employee ID

From (mm/yy) To (mm/yy)

Address Phone Number

City State

Country Postal Code

Job Title Department Reason of Leaving
Designation Annual CTC Gross Salary
Nature of Work HR Manager Name

Type of Industry HR Manager Phone Number

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 7 Name Employee ID

From (mm/yy) To (mm/yy)

Address Phone Number

City State

Country Postal Code

Job Title Department Reason of Leaving
Designation Annual CTC Gross Salary
Nature of Work HR Manager Name

Type of Industry HR Manager Phone Number

Employment Record
If you are still employed in this organization, please fill in the date before which you would not like the verification to be initiated in the “To” column.
If you are not sure or would like to intimate this date later, please write 'Still Employed'
Employer 8 Name Employee ID

From (mm/yy) To (mm/yy)

Address Phone Number

City State

Country Postal Code

Job Title Department Reason of Leaving
Designation Annual CTC Gross Salary
Nature of Work HR Manager Name

Type of Industry HR Manager Phone Number

 Achievements if any:
1
2
3

Reference Details:
(Give particulars of two referees, not related to you and also company colleagues:)
S. No Name Company Designation Location Contact No
1 CECIL MAGADHI SOFTWARE CHENNAI 9884265047
2 NANDHA DOFA SOFTWARE CHENNAI 8840289101

Other Details:

Are you prepared to work or to be transferred anywhere in

Yes
India?
If no reasons
Have you applied or attended an Interview with us before? No
If yes,Position details/Year
Do you have any service bond in your current assignment No
If yes no. of yrs & completion date
Total experience 9 YEARS
Total relevant experience 9 YEARS
Are you currently employed? Yes
Expected CTC 1300000 ANNUAL
Notice period 1 Month

Current Compensation Details

Annual/Statutory
(Rs.)
Monthly LTA :
Basic : Medical Reimb :
HRA : Bonus/Incentive :
Conveyance : Superannuation :
………….. : Gratuity :
………….. : PF :
………….. : ………………. :
………….. : ………………. :
………….. : ………………. :
………….. : ………………. :
………….. :
………….. :
………….. :
Total (A) 0 Total (B) 0
Gross Salary 0
Last Salary Revision Date:

Have you ever been considered for employment in TII or, any of the group companies? If yes :

Position :
Date :
Interviewed by :
Location :

Emergency Contact Details

Name

Mobile Landline

Address 23/3,ANNA NAGAR,PUDUCHERRY-605008

Relationship
 Affix
Passport Size
Photograph

605008
NIL

87

068979161

Grade
/percentage
68%
88%
85%

Remark, if any

AL AUTOMATION
 Tube Investment of India Ltd
Recruitment Checklist (To be filled by Recruiter)

Name DONEE MOHANRAJ

Designation SBU
Date Of Offer DOJ
Department UAN No.
Grade New PF No.
Work Location Emp No.
Reporting Reporting Manager
Manager Name Code
Source Mapping Location
Division
Sl No Description Status
1 MRF Sheet
2 Interview evaluation sheet
3 Resume
4 Application Form
5 Psychometric & Other Test Reports
6 Previous Employment DOCs
CTC details
7 (Last 3 month payslip/Salary Revision)
8 Educational Certificates
9 Salary Comparison Sheet
10 Letter of Intent
11 Medical Fitness report
Relieving Letter/Resignation Accept.
12 (Immediate Previous Employment)
13 Appointment Order
14 Supplementary terms of service
15 General service Conditions
16 ID Proof
17 Address Proof
18 Aadhar Card
19 Pan Card
20 Joining report
21 PF Nomination
22 PF Enrollment Form
23 PF Settlement Form
24 Gratuity Nomination
25 LFA declaration form
26 Factories Act Form No:34
27 Insurance Nomination form
28 BG Verification Initiated /Report attached
29 Passport Size photo
30 Cheque leaf
31 Code of conduct acknowledgment
32 Service Agreement (if Any)

Onboarding done by

* Employee code will be given by corporate HR Name:

Emp ID :
Signature :
Date:
 Tube Investments of India Ltd.

JOINING REPORT
F
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Date: 30-Dec-99
P
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DONEE MOHANRAJ
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234, NSC Bose road, Dare House, a
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Further to your "Offer of Appointment" dated 30-Dec-99 t Place of reporting
Example: Corporate
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I have reported for duty on 30-Dec-99
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1 Name (In Block Letters) DONEE MOHANRAJ

2 Father's / Husband's Name JACCINTHA MARY JP

3 Date of Birth 15.11.1993

4 Sex MALE

5 Marital Status MARRIED

6 Account Number

Permanent 23/3,ANNA NAGAR,PUDUCHERRY-605008

7 Address

Temporary 6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

8 Date of Joining EPF & EPS 30-Dec-99

PART - A (EPF)

I here by nominate the person(s) / cancel the nomination made by me previously and nominate, the person(s) mentioned below to receive the amount standing to my credit in the Employees'
Provident Fund, in the event of my death.

Nominee's relationship with the member Total amount or share of If the nominee is a minor, name & address & relationship of the
(Pick from drop box) Name & Address of the Nominee/ Nominees Date of Birth accumulations in provident fund to guardian who may receive the amount during the minority of
be paid to each nominee nominee

Provide one or two nominee

share shouldn’t be more tha

1 2 3 4 5

#N/A #N/A

#N/A #N/A

#N/A #N/A

1 Certified that I have no family as defined in para 2(g) of the Employee's Provident Fund Scheme

1952 and should I acquire a family hereafter the above nomination should be deemed as cancelled

2 Certified that my father / mother is / are depended upon me.

3 Unmarried members in the absence of dependent parents may nominate any other person to

receive the shares

4 Strike out whichever is not applicable.

Note: A Fresh nomination shall be made by the member on his/her marriage and any nomination
made before such marriage shall be deemed to be invalid

Signature or thumb impression of the Subscriber

 PART - B (EPS)
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

S.No Name of the Family Members Address Date of Birth Relationship

1 #N/A #N/A

2 #N/A #N/A

3 #N/A #N/A

4 #N/A #N/A

5 #N/A #N/A

Certified that I have no family as defined in para 2 (vii) of the Employee's Pension Scheme 1995 and 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

#N/A #N/A

#N/A #N/A

Date: 30-Dec-99

Signature/ Thumb impression of the subscriber

Strike out whichever is not applicable

CERTIFICATE BY EMPLOYER

Certified that the above declaration and nomination has been signed/ thumb impressed before me by Shri/

Smt./Kumari DONEE MOHANRAJ employed in my establishment after he/ she has read the

entry/ entries have been read over to him/ her by me and got confirmed by him/ her.

Place: 0

Date: 30-Dec-99 Name & Address of the Establishment

Designation: 30/Dec/99 Or Rubber Stamp Thereon

 PF No 0

Name DONEE MOHANRAJ

Fathers/Husband Name #N/A

Date of Birth 15.11.1993

Date of Joining 30-Dec-99

Unit 0

Clock / Roll No 0

UAN No 0

Aadhar No 575068979161

Permanent Address Present Address

23/3,ANNA NAGAR,PUDUCHERRY-605008 6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

Bank Name 0

Account No 0

Branch 0

IFSC Code 0

Address 6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

Signature of the Employee Signature of the Unit HR

To be forwarded along with the Nomination Form

 APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT

(Please fill in all the columns in BOLD letters)

Date 30-Dec-99

To

The Trustees

Tube Investment of India,

234, NSC Bose road, Dare House,

Chennai-600001

Sir

I herewith submit my PF claim form and request you to kindly settle my PF at the earlist.

PF No. Employee ID 0 Unit 0

Mobile No: 9940634155

Name DONEE MOHANRAJ

Email : TONYIMMAN0615@GMAIL.COM

Father's/ Husband's Name #N/A

Date of Birth 15.11.1993 Date of Joining 12/30/1899 Date of Leaving

Retirement Resignation VRS Others

Reason for leaving (Select yes/no which is applicable)

Mode of Payment Cheque Directly to my Residence Credit to my bank A/c

Directly

* Mandatory Address for communication Bank Details

Bank Name 0

Account No 0

6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

Br & Address 0

Pin Code 605008

RTGS/ IFSC 0
Code
I hereby solemnly declare that since last two months I am not employed in any establishment to which EPF

Act 1952 act is applicable.

FINAL SETTLEMENT

GROSS SALARY 12% 3.67% 8.33% VPF

Employee Signature

Unit HR Signature

PF-Authorised Signatory

Hewit - Team Leader

 Tube Investments of India Ltd.

Name of the employee : DONEE MOHANRAJ

Designation : 0

Address of the employee :

6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127

I hereby require that in the event of my death before resuming work,the balanceof my pay due for the
Verify name and
Relationship
period of leave with wages and wages not availed of shall be paid to

who is my and resides at

Witness:

Signature of Employee
To

Tube Investment of India Ltd,

234, NSC Bose road, Dare House,

Chennai-600001

1. I Thiru / Thirumathi / Selvi DONEE MOHANRAJ

(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).

Relationship Age of
Name in Full with Full Address of Nominee with the D.O.B Nominee Proportion by which gratuity will be shared.
Employee

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

#N/A #N/A #N/A

#N/A #N/A #N/A

STATEMENT

1. Name of the employee in full DONEE MOHANRAJ

2. Sex MALE

3. Religion CHRISTIAN

4. Whether unmarried/married/widow/widower MARRIED

5. Department/ Branch/ Section where employed 30-Dec-99

6. Postheld with Ticket No. or Serial No. if any 0

7. Date of Appointment 30-Dec-99

8. Permanent Address 23/3,ANNA NAGAR,PUDUCHERRY-605008

Place: 0

Date: 0

Signature / Thumb-impression of the Employee

 DECLARATION BY WITNESS

Nomination signed / thumb-impressed before me

NAME IN FULL AND FULL ADDRESS OF WITNESS Signature of Witness

1 1

2 2

Place:

Date:

CERTIFICATE BY THE EMPLOYER

Certified that the particulars of the above nomination have been verified and recorded in this establishment

Employee's Reference Name and address of the establishment or

No., if any rubberstamp thereof.

Date: 30-Dec-99

Signature of the Employer / Officer

/Authorized Designation

ACKNOWLEDGEMENT BY THE EMPLOYEE

Received the duplicate copy of nomination in Form "F" filled by me and duly certified by the employer

Date: 30-Dec-99 Signature of the employee

Strike out the words / Paragraphs not applicable.

** NOTE: Strike out the words/ paragraphs not applicable

 Tube Investment of India Ltd.

LFA DECLARATION FORM

Employee Preference for LFA

Employee No. : 0 Employee Name: DONEE MOHANRAJ

During the time of offer,If

you have selected
Option 1 Select No
Option 2 Select Yes

I hereby request to convert my annual LFA amount into a monthly special allowance subject to

deduction of taxes as applicable (please select Yes or No from the dropdown list)

• I understand that this option once exercised cannot be revoked in future and that my
LFA will be permanently converted into a taxable monthly allowance
• I also understand that any increase in my income tax liability, arising out of opting for a
monthly allowance in lieu of LFA will be on my account

Date: 30-Dec-99 Signature of employee

 Tube Investment of India Ltd.

Group Health Insurance - Information Sheet

Name of the Employee DONEE MOHANRAJ SBU 0

Employee Code 0 Grade 0 Location 0

Please provide the following information for the group health insurance policy.
You can opt to cover either the both parents/both the In laws (covering one of each is not possible)

SI. Relationship Name Date of Birth Gender Age

1 Self DONEE MOHANRAJ 15.11.1993 #VALUE!

2 Spouse JACCINTHA MARY JP 08.09.1996 #VALUE!

3 Child 1 JONATHAN D 02.08.2021 #VALUE!

4 Child 2 - - #VALUE!

5 Father MOHANRAJ D 30.04.1959 #VALUE!

6 Mother LOURDE MARIE M 03.07.1966 #VALUE!

7 Father-in-law

8 Mother-in-law

Date of Joining : 12/30/1899 Signature of employee

 New Form No.11- Declaration Form

EMPLOYEES PROVIDENT FUND ORGANIZATION (To be retained by the employer for future reference)

Employees provident funds scheme, 1952 (paragraph 34 & 57) &

Verify details from 1 to 8
Employees pension scheme 1995 (paragraph 24) Emp Code: 0

Company: Tube Investements of India

(Declaration by a person taking up employment in any establishment on which EPF Scheme, 1952 end /of EPS1995 is applicable)

1 Name of the member DONEE MOHANRAJ

2 Father’s Name ( ) Spouse’s Name ( ) #N/A

(Please Tick Whichever Is Applicable)
3 Date of Birth (DD/MM/YYYY) 15.11.1993

4 Gender: ( Male / Female /Transgender ) MALE

5 Marital Status (Married /Unmarried /Widow/Divorce) MARRIED

a)Email ID: TONYIMMAN0615@GMAIL.COM

6
(b)Mobile No: 9940634155

7* Whether earlier a member of Employees ‘provident Fund Scheme 1952

8* Whether earlier a member of Employees ‘Pension Scheme ,1995

If response to any or both of (7) & (8) above is yes. MANDATORY FILL UP THE (COLUMN 9)

a) Universal Account Number(UAN) 0

b) Previous PF a/c No

9 c) Date of exit from previous employment (DD/MM/YYY) Fill up necessa

blank column
d) Scheme Certificate No (if Issued )

e) Pension Payment Order (PPO)No (if Issued)

a) International Worker:

b) If Yes , State Country Of Origin (India /Name of Other Country)

10
c) Passport No 0

d) Validity Of Passport (DD/MM/YYY) to(DD/MM/YYY) 0

KYC Details: (attach Self attested copies of following KYCs) **

a) Bank Account No .& IFSC code 0 0

11 b) AADHAR Number (12 Digit) 575068979161

c) Permanent Account Number (PAN),If available BTDPD6049M

1) Certified that the Particulars are true to the best of my Knowledge UNDERTAKING
2) I authorize EPFO to use my Aadhar for verification / 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(The Transfer Would be possible only if
the identified KYC details approved by previous employer has been verified by present employer )
4) In case of changes In above
Date: details the same Will be intimate to employer at the earliest
12/30/1899 Signature of Member

Place: 0

DECLARATION BY PRESENT EMPLOYER

A) The member Mr./Ms./Mrs DONEE MOHANRAJ has joined on 30-Dec-99 and has been allotted PF Number 0

B) In case person was earlier not a member of EPF Scheme ,1952 and EPS,1995

 (Post allotment of UAN ) The UAN Allotted for the member is 0

 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

C) In case the person was earlier a member of EPF Scheme ,1952 and EPS, 1995:

 The above PF account number /UAN of the member as mentioned in (a) above has been tagged with his /her UAN/previous member ID as declared by member

 Please Tick the Appropriate Option

 The KYC details of the above member in the UAN database have been approved with digital signature Certificate and transfer request has been generated on portal.
 As the DSC of establishment are not registered With EPFO the member has been informed to file physical claim (Form13) for transfer of funds from his previous
establishment.
Date: 12/30/1899 Signature of Employer With seal of Establishment
 Tube Investment of India Ltd.

Option for Superannuation

To,
HR Department,
Tube Investments of India,
Chennai.
This is further to your mail seeking my option on Superannuation. I am indicating my options below.
Click the below option for Future Payments:

Option A: I would like to continue with the company’s contribution to the Superannuation Fund.
Past Balance:
Option B: I would like to be paid the Superannuation Fund Allowance with my monthly salary. I understand and agree that, when I choose this option
If you choose Option B above, please confirm the following option.
I understand that the balance amount in my account in the company’s Superanuation Fund can remain with the Fund. I will choose the method of settlement of this balance
from the fund at the time of resignation / retirement from the company’s services.
I also understand that once I give my option, it cannot be changed.
Sincerely,

Name DONEE MOHANRAJ

Emp No 0

Signature
Date: 0
 Tube Investment of India Ltd.

FAMILY RELIEF SCHEME

To,
Corporate HR,
Tube investment of India,
Chennai.

I have gone through the provisions of the Management Staff Family Relief Scheme of Tube Investments of India Ltd. and understood the contents.
I would like to participate in the Scheme and hereby authorise the Management to deduct Rs. 5/- per month from my salary towards my contribution, I would also request
that the deductions be made effective from my date of joining the Company and continued during my service with the Company.

I hereby nominate Mrs. / Ms. / Mr.

(relationship)
#N/A as my nominee under the Scheme.

I undertake to abide by the rules governing the Scheme.

DONEE MOHANRAJ
NAME
0
DESIGNATION
0
SBU
0
LOCATION

Date: 0 Signature of employee

 Tube Investment of India Ltd.

SENIOR STAFF SUPERANNUATION FORM

To,
TRUSTEE,
Tube investment of India,
Chennai.

I DONEE MOHANRAJ member of the TII Superannuation Fund, hereby appoint

in terms of the Rule 22 of rules governing the Fund, my (relationship)*

Name #N/A and whose address is

#N/A

as a person to whom the monies payable under the Fund shall be paid in the event of my death.

DONEE MOHANRAJ
NAME
0
DESIGNATION
0
SBU
0
LOCATION

Date: 0 Signature of employee

WITNESSES :

1) Name and address :

Signature

2) Name and address :

Signature
 TUBE INVESTMENTS OF INDIA LTD.,
CHENNAI
PERSONAL DATA FORM (MS / SS / TRAINEES)
DATE OF JOINING 30/Dec/99 EMPLOYEE NAME : DONEE MOHANRAJ SEX MALE DATE OF BIRTH
EMPLOYEE NUMBER 0 15.11.1993
PERSONAL DETAILS

MARITAL STATUS* PLACE OF BIRTH NATIVE STATE NATIONALITY RELIGION

MARRIED INDIAN CHRISTIAN
M : MOTHER TONGUE R W S R W S R W S
LANGUAGES
KNOWN

R : READ ( √ ) WHICHEVER
APPLICABLE
M: TAMIL English Hindi
W : WRITE YES NO YES YES YES YES YES YES YES
S : SPEAK
PRESENT ADDRESS : PERMANENT ADDRESS : IN CASE OF EMERGENCY CONTACT :
NAME : 0
RELATIONSHIP : 0
ADDRESS :
ADDRESS DETAILS

6,SRS AVNUE,MELAKOTTAYUR,CHENNAI-600127 23/3,ANNA NAGAR,PUDUCHERRY-605008

PINCODE 605008 PINCODE 605008 PINCODE

STATE : 0 STATE : 0 STATE : 0
PHONE NO. : 9940634155 PHONE NO. : 9940634155 PHONE NO. : 9940634155
MOBILE NO. : MOBILE NO. : MOBILE NO. :
E-MAIL ID : TONYIMMAN0615@GMAIL.COM
HEIGHT (CMS.) WEIGHT (KGS.) BLOOD GROUP (RH factor) PHYSICAL DISABILITY (IF ANY)
MEDICAL
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170 87 A- No

Specify Occupation / Studying

NAME DATE OF BIRTH ** IDENTITY MARKS :
(Which Class) / House Wife
Father MOHANRAJ D 30.04.1959 EX ARMY 1
FAMILY DETAILS

Mother LOURDE MARIE M 03.07.1966 - 2

Spouse JACCINTHA MARY JP 08.09.1996 Software
Child 1 JONATHAN D SEX Male 02.08.2021 - Please affix
your stamp
Child 2 - SEX - - - size
#N/A #N/A #N/A photograph
Child 3 SEX #N/A
* UNMARRIED, MARRIED, WIDOW (ER), SEPARATED
SIGNATURE : SIGNATURE :
** INDICATED 'Y' IF STAYING WITH YOU AND 'N' IF NOT STAYING WITH YOU
 EMPLOYEE NAME : DONEE MOHANRAJ EMP. NO: 0

P*
AWARD /
DURATION MONTH & % OF MARK'S
NAME OF EXAMS PASSED (PLEASE LIST FROM MAJOR SUBJECTS (MENTION ONLY FOR NAME OF THE BOARD / MEDAL /
F* YEARS / YEAR OF / CLASS
SCHOOL AND UPWARD) DEGREE AND UPWARD) UNIVERSITY / INSTITUTION DISTINCTION IF
MONTHS PASS OBTAINED
ANY
C*

B tech EEE 4 PONDICHERRY ENGINEERING COLLEGE 2015 68%

HSC MATH/CHEM/PHY 1 SEVENTH DAY ADVENTIST 2011 88%

EDUCATIONAL DETAILS

SSLC MATH/SCIENCE 1 KENDRIYA VIDYLAYA 2009 85%

0 0 0 0 0 0%

0 0 0 0 0 0%

0 0 0 0 0 0%

0 0 0 0 0 0%

0 0 0 0 0 0%

* P - PART TIME; F - FULL TIME; C - CORRESPONDENCE

PASSPORT NUMBER NAME AS IN PASSPORT PROFESSION AS IN PASSPORT

PASSPORT DETAILS

0 0
PLACE OF ISSUE : COUNTRIES VALID FOR :
DATE OF ISSUE VALID UPTO 0
COUNTRIES TRAVELLED :
VISAS APPLIED FOR :

DRIVING LICENCE NUMBER : 0

DETAIL
PAN

PERMANENT ACCOUNT NUMBER (PAN CARD) : BTDPD6049M

SIGNATURE :
 EMPLOYEE NAME : DONEE MOHANRAJ EMP. NO: 0

1 ORGANISATION NAME* : SITRA INFOTECH PVT LTD DESIGNATION : PLC SCADA ENGINEER

LOCATION : HYDERABAD FROM TO DEPARTMENT : PROJECTS

TYPE OF INDUSTRY : 0 12.11.2015 29.12.2019 GROSS SALARY P.M. : 28000

NATURE OF WORK : PERSONAL ANNUAL CTC : 400000
REASON FOR LEAVING :
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2 ORGANISATION NAME : PREIPOLAR ENGINEERING PVT LTD DESIGNATION : SENIOR ENGINEER

LOCATION : CHENNAI FROM TO DEPARTMENT : AUTOMATION

TYPE OF INDUSTRY : 0 24.01.2020 26.12.2021 GROSS SALARY P.M. : 46000

NATURE OF WORK : DESIGNING & COMMISSIONING PERSONAL ANNUAL CTC : 650000
REASON FOR LEAVING :

3 ORGANISATION NAME : SCHNEIDER ELECTRIC SYSTEMS INDIA PVT LTD DESIGNATION : DEPUTY MANAGER

LOCATION : CHENNAI FROM TO DEPARTMENT : PROJECTS

TYPR OF INDUSTRY : 0 27.12.2021 25.05.2024 GROSS SALARY P.M. : 78000

NATURE OF WORK : DESIGNING & COMMISSIONING PERSONAL ANNUAL CTC : 1020000
REASON FOR LEAVING :

4 ORGANISATION NAME : 0 DESIGNATION : 0

LOCATION : 0 FROM TO DEPARTMENT : 0
TYPR OF INDUSTRY : 0 30-Dec-99 30-Dec-99 GROSS SALARY P.M. : 0
PREVIOUS EXPERIENCE DETAILS

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REASON FOR LEAVING :

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8 ORGANISATION NAME :
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* KINDLY FILL IN ASCENDING ORDER OF EXPERIENCE

SIGNATURE :

EMPLOYEE NAME : DONEE MOHANRAJ EMP. NO: 0

GIVE BELOW THE DETAILS OF IMPORTANT TRAININGS ATTENDED BY YOU FROM THE START OF YOUR CAREER CHRONOLOGICALLY

COURSE NAME ORGANISER (MENTION ALSO PLACE) FROM DATE TO DATE

PGDA SMEC 42339 42491

0 0 0 0
TRAINING DETAILS

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
 DECLARATION OF NOMINATION
IF YOU ARE A TRAINEE, PLEASE FILL ONLY THE DECLARATION OF PF NOMINATION (or) IF YOU ARE A SUPERVIORY STAFF, PLEASE FILL ONLY THE DECLARATION OF PF & GRATUITY NOMINATION

Name in Full with Full Address of Nominee(s) RELATIONSHIP % OF SHARE AGE

0 #N/A #N/A
PROVIDENT FUND
0 #N/A #N/A

0 #N/A #N/A
GRATUITY
0 #N/A #N/A

SUPERANNUATION FUND #N/A #N/A

FAMILY RELIEF SCHEME 0 #N/A #N/A

SIGNATURE :

NAME OF THE EMPLOYEE DONEE MOHANRAJ

DESIGNATION 0

GRADE 0

SBU 0

PLACE OF POSTING 0

DATE 30/Dec/99