AUTHORIZATION / DECLARATION

(Letter of Declaration)

Date:

I Mr. / Ms. hereby declare that Bajaj Finserv Ventures Ltd. Offer
Location
(Location mentioned in Offer Letter) is:

a) Within 50 KM from my hometown

b) Within 50 KM from my current work location

My Marital Status is – SINGLE MARRIED

If SINGLE
My parents stay near Bajaj Finserv Ventures Ltd. Offered location – Yes No

If MARRIED
My spouse (husband / wife) stays near Bajaj Finserv Ventures Ltd. Offered location – Yes No

I am certifying above information is true and attaching below documentary proof as evidence:

a) Gas connection passbook

b) Rent agreement

c) Electricity bill

d) Driving License

e) Aadhar Card

f) Passport

g) Last month Salary Slip / Employer Certificate

Signature :

Place :
 (Letter of Authorization)

Date:

I Mr./Mrs. S/o or D/o , aged about yrs, having PAN No. ,

hereby agree and authorize Bajaj Finserv Ventures Limited (“the Company”) and/or its nominated
representatives, Affiliates, Third Party / Service Provider, Agents including their employee / legal
representatives (collectively referred to as “Authorized Person”) to conduct enquiry as may be necessary,
at the Company’s discretion. The said Authorized Person may use all or any of my personal information,
employment related informations, and Sensitive Personal Data along with supporting documents (“Data /
Information”) in order do or perform enquiry or verification, including the credit verification of my
personal financial details/creditworthiness from the credit bureau agency(s). Further, I hereby confirm to
release the Authorized Person from any or all liability(s) / Claims / damages on account of such disclosure
of my said Data / Information. Further, I hereby confirm that I will join Bajaj Finserv Ventures Ltd. only
post last working day from my current organization.

Upon verification, if any information submitted by me is found to be incorrect, my candidature is liable to

be rejected or if such incorrectness is realised by the organisation after my joining the organisation, my
services shall be subjected to termination.

Signature
Name in Block Capitals
Date of Birth
Date
PAN Number