_J L

IIFL Employee Pe rsonal Details-A-5(ii)

LETTER OF AUTHORIZATION AND DECLARATION

T O WHO MSO EVER I T MAY CONCERN

I hereby declare that all the above information provided by me is true and correct and that I have not held back any information that, if
disclosed, would be a factor in determining my eligibility for employment and I undertake that should any information given here is found to
be false, I shall be liable for dismissal.

I confirm that I have authorized, without my prior consent any individual , corporate or any other private and public entity to furnish
information to verify and validate the information, I have provided, including my employment, my background, professional standing, work
history, qualifications and criminal records (if any).

I unconditionally release and hold harmless any individual, corporation, or private or public entity from any and all causes of action that
might arise from furnishing to India lnfoline ("Company") and any other outside agency, information that they may request pursuant to this
release.

I understand that during my first login to the company's corporate interface - IWIN, I shall be prompted with the company's 'Terms and
Conditions' and clicking on the ' I Agree' tab will imply my digital acceptance of the same, which will make it binding upon me to follow the
Company's listed procedures and confidential norms.

I hereby declare that I am not holding any agency license from any insurance company.

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SIGNATURE -

Date:

Place: --------------

NOMINEE DETA L
I S:
Sr. Name ofNominee Relationship Date of Birth Nominee Add ress
No withNominee ofNominee

1. ADHESH TOMAR HOUSE NO 216 VILLAGE HAIDER NAGAR POST

BAGHAR MUZAFFARNAGAR UTTER PRADESH
FATHER 01-Jan-1970 (251306)