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AgroGloble Solutions
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0% found this document useful (0 votes)
138 views8 pagesJoining Kit Agroglobe Soltutions Private Limited
AgroGloble Solutions
Uploaded by
Devansh PachauriCopyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
/ 8
Agroglobe Solutions Private Limited
220, 2 Floor, Gera Imperium Rise, Hinjavadi, Pune (MH) 411057
Personal Details
Full Name
Father/ Husband Name
Date of Birth
Nationality
PAN Card
‘AADHAAR No
Address
Photo
Village
Tehsil/ TQ
Dist
State
PIN Code
‘Mob No
Bank Account Details
Name on Passbook
Bank Name
‘Account Number
IFSC Code
Bank Branch
Educational Details
Degree | Passing Yr
Percentages
Post Graduation
Passing Vr
Percentage
Family Information
Father Name
Mother Name
Wife/ Husband Name
Child Name 1& Gender
Child Name 2 & Gender
Child Name 3 & Gender
| am ready to work with Agroglobe Solutions Pvt Ltd, with their contracts in different company with
terms & conditions applied by ASPL. The said work is contractual, seasonal & transferable w!
accept. I will accept the renumeration given by ASPL. | will adhere to rules & regulation set by ASPL to
carry out operations day today basis. | will deliver my duties with good moral & conduct.
Declaration
Date:
Sign:
Place:
Name: FORM - 2 ( Revised)
NOMINATION AND DECLARATION FORM
FOR EXEMPTED / UNEXEMPTED ESTABLISHMENTS
Daclaratin and Nomination Fern Urder the Employee's Provident Funds & Employees! Pansion Scheme
(Paragraph 56 8 6: (1) oF the Emelayoos’ Prouident Furd Sehome, 1982 & Paragraph 18 of to Employece's Pension Schame, 1095)
4 Name (In Block Letters)
2 Father's / Husband's Name
3 Dato of Birth
4 Sox
5 Marital Status
6 Account Number
7 Address Permanent:
‘Temporary
8 Date of Joining
EPF
EPS
PART -A(EPF)
| here by nominate the person(s)‘ cancel the nomination made by me previously and person(s) mentioned below to
receive the amount standing to my credit in the Employees’ Prov det Fund. in he event af my death.
Name aAddersethe | Warinessrelatorship | Dareot | Total ameunt of shave of ite nerinas is marnane &
Romisve/ Nominees | witvanememper | Brey | accumulation in prover Ussatene ratioship ths
fund ine padi mark neminen | gunn whn my “ero te court
7 z 3 7 z
1 Certified thal 1 have no family as defined in para 2 (g) of the Employee's Provident Func Scheie 1982 and should |
xcquire a family hereafterthe above nomination should be deemedas cancelled
2 Certified that my father/ mothers /are depended upon me,
3 Unmarried membersin the absence of dependent parents may nominate any other person to receive the shares.
‘Note: A Frosh nominaticn shal be made by the member on
hishhermarrage and eny nominaton made before such
‘marrage shall be decmed to bo irval
Signature or thumb impreesion of the Subseriber PART- 6 (EFS)
| horeby furnish below particulars of tho mambars of my family who would be algibie to receive widow/ehilaran pension
inthe event of my death
Name of the Family Members ‘Address: Date of Binh | Relationship
a
he
‘Certified that | have no family as defined in pare 2 (vl) of the Employee's Pension Scheme 1995 and should | acquire &
‘amly hereatter the above nomination should be deemed as cancelled
|Inaroby nominata tha following person for recaking the monthly w daw pans on (admissible undar para 16(2) (a) (I) & (iin
‘the evant of my death with out leaving any eligible family mambor for recelvirg pension.
Name &Acldress cf the Nominee: Date of Bich Relationship with the member
Date:
‘Signature / Thumb impression of the subscriber
CERTIFICATE BY EMPLOYER
Cortitied that the stove daciaration and nomination has been sigredthumbs imprassed before Shri / Smt / Kum
employed in my establist ment after he/she has read the entry / ertries have been read over to himvner by me and got
confirmed by hin her.
Place:
‘Signature of the employer
Name & Address of the Establishment New Form No.11- Declaration Form
EMPLOYEES PROVIDENT FUND ORGANIZATION Tobe rota nod by tho employe ee Tule rteroneo)
Employocs provider funos cenome, 1952 (paragragh $4 & 87) &
Employase pension scheme 1006 (paragraph 24) Emp Code:
Company:
(Decieraton by a gerson taking up emoleymentin any estabfshment on which EPF Schome, 1952 end ‘of EPS1995 ia applicable)
+ [Name of the mortar
habersare( | Spouse's Name |
(Plone Tick hic bs Apia)
Tate of Reh (ADIMAMLYYYY)
(Gander ( Male Fea FTeanagender |
‘Mesital Status Mesried ‘Unmaried MidowiCivorce)
(e}Emai ID
(obi No-
T- | Whethor caro a momoor of Employees previdont Fund Scheme 1852 vee No
1° | Whether care @ mame" of Employees Pasion Scheme. 1885, vere Ne
Wrorponae to any or both of (7) & (8) above iz yea. MANDATORY FILL UP THE (COLUMN 9)
8} Univorsal Accourt NamboriUAN)
© [biProvousPratNe, LAP[HVD] ESTCODE]EXTN BNO.
©) Dale of eri thon pravhaos empleymant (DDN YY)
1 Scheme Certiicale No (if lasued )
1} Panion Paymant Owdar (PPOINe (lesued) 10
ia lerrational Wort Yan No
10 | bj Yen, State Country OF Orgin (ndin Name of OFer Country)
©) Peasant No
1 Vliity OF Passport (NOHURWY YY) f(A)
KYG Details: (aftach Self attested copish of following KYCs) =
1) Bank Account No & IFS code
DIAADHAR Numtor 12 Digi
¢) Permanent Account Number (PANLIT avaliable
Lf eRe AOE NUTT AN vere
UNDERTAKING
41) Ceries thatthe Paiculars are rue to the best of my Knowledge
2) authorize EPFO to use my Aadna’ for verification ¢ KYC purpose for service doltvory
13) indy transfer the furs anc service datas If aaplcadie df appscable rm the previous PF account as dec ted aboxe tothe presant PF
‘Anonurr(The Transier Winnie possibie only the Henaiied KY: detels apreved ty peevions em pyer has been ware by presert
empoyer
42) n caso of changes In above dosaile fo samo Wil be inbmato to omployor at the eartost
1
Date:
Flaca Signature o' Member
DECLARATION BY PRESENT EMPLOYER
AV The member Mesh rs has joined on ‘and nas been allated PF Number
B} ln case person was wally pola mamber of EPF Scherne 1082 snd EPS. 1005
1 (Post aotment of VAN } The LAN Allo forthe member i...
Please lek the Appropriate Op in:
(9 The KYE details of the shave mamber in the UAN database
Y Have wo! boun uploads
| Have ten uploaded but not approved
17 Have ta2n uploaded ard eppraved with DSC
case “ho porson war carbo a momiber of EPF Schomo 1952 and EPS, 1995
The aboe PF account rummber JAN ol the meer as inentoned (a) above has beer lagged win his her UANGatevous member
IDias declared by memibe
ase Tick the Appropriate Option
~ The RYE desis oft ebove memerin me UAN dlaoase have Geen approved wi di sgnature Gera anc wane requet
has been geveraled 2n port
fe DSC of esblehment ee ct registered With EPFO Te members been formed ee phys a (Farm!) or tener
‘of funds from his previous establichngnt,
Date
Sigroturo of Employer With soa of Establshrront ¥& ESIC DECLARATION FORM Form-1
Nis a
(A) INSUREDPERSON'S PARTICULARS (8) EMPLOYER'S PARTICULARS:
4. Inewranca Ne, 9. Employars Coda No,
2 Name in Black eters s0-Date of Apooinimer Day Ion’ Year
H Fabrectitancs Name & Adress ofthe Emp over
4 Date of Br Day 5 Maria] SUNY
Sas
BSe [ab
7 ProsortAdirass ‘Pon anont Addins Incase of ay previaus enpmenl veas Mlup the dela ay ude.
{3} Previos ns, Ne;
player's Cade No.
‘0h Nam & Actas ofthe Emp ayer
Pin Cade in Code
Brach Offos isoensary emralladdress
(c) Detalls of Nominee wis 71 of ESI Act 1948 / Rule -56 (2) of ESI (Central) Rules, 1950 for payment of cash benefit in
the event of death,
Name Ralationship. Address
hereby declare thal the particulars given by me are correct to the best af my know!
the corporation any change
ige and belief. | undertake to intimate
in the membership of my famiy within 15 days of such change,
Counter signature by the employer Signature /T.1 of IP
Signature with seal
(D)Family Particulars of insured person
S.Ne. Name Qaleo' ith; | Rewicnshin sMhetheresidng | F'No slate Place of Resdence
Age oson date | ith the ti hier,
alfling frm | Ereloyee
Yes_|_No
ESI Corporation Temporary Identity Car {Walid for 3 menth fram the date of appointment]
Nave
ra. No. Dato ot appaintrent|
(pice orphan)
Beanch Ofice Dispensary
Erraloyer's Cede No, & Adress
Vly
Dated Slorature fT. of LP. ‘Slonature of .NL wth sea INSTRUCTIONS:
41. Submissionof Form lis govetned by regulation 11 & 12of ESI (General) Regulations. 1950
2, "Family means.allorany ofthe following ralativas ofan insured Parson namaly.-
{WAspouse {iJA minor legitimate or adopted child dependent upon the LF. (i) A child whois wholly dependent an the eamings
Ofte 1P. and whois (@) receiving education, lil heor she allan le wye of 21 years (b) ani untnarried daughter: iv)Achid who
{infirm by reason of any physical or mental ahnormalty or Injury and is wholly dependantoa the earnings othe |P salong as
theinfirmitycont nude: (v) dapandant parants (Plaasa see Section 2 clause 11 oftha ES! Act 1948 fordatails,
3, Identity Cardis Non-Transterabie,
4, Loss ofldentity Card bereported to Employer Branch Manager immedistely.
5, Submission of false information tracts penal action Under Section 6 of ES) Act. 1948,
6, This form duly fled inmmustreach the concemed Branch Office within 10 days of appointmentof an Employee. Delay attracts
penal action under Section 85 ofthe Act, agaist employer.
7. Asan Insured person yousnd yourdenerdant family members areentiled t fll medical care, The other benefisincash
include (1) Sickness Boncft 2) Temporary Disablement honetit|3)ermancnt disablement Benefit (4) Depondants bench
‘and 9) Maternity Bereft (in case of woman employees) subject of fulfilment of contributory corditions.
8. Formore details please contact websive of ESIC at www.esic org in or contact Regional Oifice or Branch Office.
For Branch Office Use only
1=Date of alctment cf Ins No
2-Date of issue of TLC
‘3+ NameiNo, of Dispensary:
4- Whothor reciprocal Modical arrangements involved. If yes, plonse indicate:
"Signature of Branch Manager
Daipof ith! Retxionship | Wetethor residing If ot sete Place of Rsidenos
Ageasoidale ithe ith inher,
oftiingtom —_Empoyee
Yes] Ne Siete FORM 'F*
[Seo sub-rule (1) of rule 6]
Nomination
To
[Give herename or description ofthe establish ment with fulladdress]
1. ShutiSovimatilKumar whose particulars aregiven in he statement below, [Name in fullhere] heresynominate
the porsans} mentionce belovetorosive tye gratuity payable aftor my death asalsotho gratuity standing tomy crodtt nthe
‘event of my death before that amount has become payable, or having becom payablehas notbeen paidandadrectthatthe
sald amountot gratuity shal be pad in proportionindicatee againstthe name(s) of thenomines{s).
2. hereby cerify thatthe person(s) mentionedis al'are member(s) of my amily withinthe meaning of cause {h) of section (2) af
thePaymentol Gratuily Act, 1972.
3. Thereby declare tat Ihave na family within the meaning of cause (h) os
ction (2) ofthe said.
4, (2) My fatherimotheriparentsis‘arenot dependent one. (b) my husband's fatherimothe “parents isfarenot dependenton my
husband,
5, Ihaveexelided my husband from my farily 9y a notice dated the to the Contvollng Authority in terms o* the proviso to clause
{h)ofscction 2 ofthe said Act.
6. Nomination made here n invalidates my previous nomination.
Nominee(s)
‘Name in full with ful adcress | Relationship with the: ‘Age of nominee Proportion by which the of
nominac(a) ‘ampioyoo gratuity will bo sharod
1
2
3
4
oon
Statement
1. Name of errployes in ‘ul
Sex
Religion.
4. Whether unmantecarieciwidowvidower.
5. Department RranchSaction where employed.
6, Post hold with Ticket or Serial No, Hany.
7. Date of appointment.
8 Permanent address. Village Thana ‘Suo-
