TCS Confidential

TCS BACKGROUND CHECK FORM

Basic Details

TCSL Applicant ID : 1154571

CT Reference Number : DT20173854729

Name Of Applicant : Hema Chaudhary

Date Of Birth : 01/11/1997

Nationality : India

Email ID : hemachaudhary.1996@gmail.com

Pan Card No. : BXZPC5159F

Passport Number : T2122444

Place Of Issue : GHAZIABAD

Date Of Issue : 22/03/2019

Date Of Expiry : 21/03/2029

ECNR Check : No

Present Residential Address

House No./Apartment Name/Block No. : 67c,67b(Part),Ganesh Puram,Baroli Ahir
Road/Street/Lane : Shamsabad Road

City : Agra State : Uttar Pradesh Country : India Pincode : 282001

Telephone : 91 9410420721 Mobile : 91 7830082180

Landmark
Tv Tower
Period of Stay
From : 25/05/2014 To : 18/04/2019

Permanent Residential Address

House No./Apartment Name/Block No. : 67c,67b(Part),Ganesh Puram,Baroli Ahir
Road/Street/Lane : Shamsabad Road

City : Agra State : Uttar Pradesh Country : India Pincode : 282001

Telephone : 91 9410420721 Mobile : 91 7830082180

Landmark
Tv Tower
Period of Stay
From : 25/05/2014 To : 18/04/2019

Other Residential Address [Longest Stay in last Seven[7] Years]

House No./Apartment Name/Block No. : 67c,67b(Part),Ganesh Puram,Baroli Ahir
Road/Street/Lane : Shamsabad Road

City : Agra State : Uttar Pradesh Country : India Pincode : 282001

Telephone : 91 9410420721 Mobile : 91 7830082180

Landmark
Tv Tower
Period of Stay
From : 25/05/2014 To : 18/04/2019

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 TCS Confidential

Academic Details

Degree
Course Name Duration Duration Course University/Institute Board Of Major Subject CGPA/Marks Total Percentage

From To Type Education Obtained Marks/CGPA

Graduate BACHELOR OF 11/08/2015 30/06/2019 Full Time Anand Engineering COMPUTER 5562.0 7000.0 79.45

TECHNOLOGY College, Agra SCIENCE AND

ENGINEERING

XII STANDARD XII 01/04/2014 30/06/2015 Full Time John Milton Public CBSE OTHERS 430.0 500.0 86.0

/ H.S.C. School

X SSC 02/04/2012 28/05/2013 Full Time Police Modern School CBSE OTHERS 9.2 10.0 92.0

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 TCS Confidential

Security Details

Are you involved in any pending and / or closed Civil / Criminal / case / proceedings / charges / enquiry prior to joining No

TCS.

Are you involved in any pending and / or closed Disciplinary / malpractices and / or any other charges / proceedings / No

enquiry / case pending against me in any University or any other educational authority / institution prior to joining TCS.

''If the answer to any of the above mentioned question is YES give full particulars of the case / arrest /detention / fine
/conviction / sentence / punishment etc. and / or the nature of the case pending in the Court / University / Educational
authority etc. at the time of filling this form.''

Reference Details

Details Reference 1 Reference 2

Reference Name: Shashank Yadav Darpan Anand

Designation: Assisstant Professor Assisstant Professor

Company/Institute Name: Anand Engineering College Anand Engineering College

Contact Number: 8755499767 8126904321

Email ID: shashankyadav@sgei.org darpananand.hitm@sgei.org

Relationship with the Applicant: Professor Professor

Period for which the reference 3.0 3.0

knows the applicant:

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 TCS Confidential

DECLARATION :

Candidate Name : Hema Chaudhary

TCSL Applicant ID : 1154571

Declaration and General Consent to Background Investigation

In connection with my application to render services to Tata Consultancy Services Ltd (the Company), I hereby agree as follows:

I certify that the information furnished in this form as well as in all other forms filled-in by me in conjunction with my employment is factually correct and subject to

verification by TCS including Reference Check and Background Verification.

I accept that an appointment given to me on this basis can be revoked and/or terminated without any notice at any time in future if any information has been found to be

false, misleading, and deliberately omitted/suppressed. As a condition of Company's consideration of my application for employment with the Company, I hereby give my

consent to the Company to investigate or cause to be investigated through any third parties my personal, educational and pre or post-employment history. I understand

that the background investigation will include, but not be limited to, verification of all information given by me to the Company. I confirm that the Company is entitled to

share such investigation report with its clients to the extent necessary in connection with the Services, which I may be required to provide to such clients. I confirm and

undertake that the Company shall incur no liability or obligation of any nature whatsoever resulting from such investigation or sharing of the investigation results as

above.I certify that I am at present in sound mental and physical condition to undertake employment with TCS. I also declare that there is no criminal case filed against

me or pending against me or I am involved in any case in any Court of law in India or abroad and no restrictions are placed on my travelling anywhere in India or abroad

for the purpose of business of the company.

I hereby declare and undertake thatI shall not resort to any unethical, unfair practices to augment my chances of selection with TCS by adopting unlawful means directly

and / or indirectly within and outside TCS and shall strictly adhere to the selection process made applicable by TCS.

My candidature for employment in the Company is liable to be rejected in the event it comes to the knowledge of TCS that I have resorted to unethical, unfair practices to

augment my chances of selection with TCS.I am fully aware that TCS is an equal opportunity employer and the decision of TCS to hire me is solely will be made on my

credentials duly validated and on the assessment of my capability to perform a role for which I am interviewed by TCS.

Your Electronic Signature is below:

Name: Hema Chaudhary

Date: 18/04/2019

Place: AGRA

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