VARIFICATION FORM
Candidate Declaration Form
Instructions: Please provide all the information requested in this form. Incomplete Candidate
Declaration Forms (CDFs) will be returned. All supporting documents must accompany this form.
Photocopies must be legible. We have included a checklist to assist you to complete your
application comprehensively.
PERSONAL DETAILS
Full Name (First/Middle/Last): Rahul Kumar Thakur _
Fathers Name/Husband’s Name: Santosh Kumar Thakur
Date of birth (DD/MM/YY): 03/09/1997 Contact Number: 7980157916 Nationality:
Indian _
Passport Number: N/A Date of issue: N/A Date of expiry: N/A _
PAN Number: BFEPT6598A _ Blood Group: B+
Personal email id: rt916368@gmail.com _ DL number: N/A
Voter ID number: RXC1643204 _
Change of Name if Applicable
Former Name/Maiden Name : N/A
Date of Name Change : N/A
Current Address Permanent Address
Door No/Street: 23/2/8 K.B. Sarani Mall road , bell 4c Door No/Street: 23/2/8 K.B. Sarani Mall road , bell 4c
City: Kolkata _ City: Kolkata _
State:West Bengal State:West Bengal
Pin: 700080 Pin:700080
Landmark: Mall road post office _ Landmark:Mall road post office
Period of stay: more than 24 years Period of stay: more than 24 years
Landline/Mobile No. 7980157916 _ Landline/Mobile No. 7980157916 _
Is your residence own or a rented place? Own Is your residence own or a rented place? Own
If rented, please provide details of the Landlord If rented, please provide details of the Landlord
Name: _ Name: _
Address: Address:
City: City:
State: _ State: _
Pin: Pin:
Landline/Mobile No. _ Landline/Mobile No. _
For Internal Use Only
VFG ID: (To be entered by Verifacts personnel only)
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Candidate Declaration Form
EDUCATION DETAILS
Client Requirements
Highest Graduation * Graduation
Name of the Course BCA
Student ID No/Enrolment No 1722630044 Duration of Study 3 years
Division/Class K2 Degree Obtained Yes
Subject Major Computer applications Course Type (Regular/Distance) Regular
Name of University MAKAUT
Name of College/Study Centre Techno India
Address of Institution EM 4, Sector V, Salt Lake
City: kolkata State: West Bengal
Pin:700091 :(Landline) 23576163/
: (Email ID) admission@technoindiagroup.com
EMPLOYMENT
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.
Immediate Previous Employment
PERMANENT EMPLOYMENT
N/A
Name of Company
Where were you employed? Registered Corporate Office Branch Office
Company Address Door No/Street
(Where you were employed) City State
Pin (Landline)
Period of employment Employee Code
Designation Remuneration
Department Reported to
Supervisor’s Designation (Email Id)
Reason for Leaving
CONTRACTUAL EMPLOYMENT
N/A
Company Name
Company Address Door No/Street
City State
Company Contact Person (Email Id)
Candidate Declaration Form
N/A
Designation (Landline)
State you reason for leaving
Can a reference be taken now? Yes No
If No, when can it be taken?
Note: Please attach legible Photo copies of the following documents relevant to the entries above
Appointment Letter, Salary slips and Release Letter / Service certificate
Authorization/ Declaration and Undertaking
If employed by EXOTIC LEARNING , I agree to provide copies of all relevant certificates. I understand that employment with
EXOTIC LEARNING is governed by their employment policies as applicable, including satisfactory information from
background checks.
I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
EXOTIC LEARNING and its representative to authenticate information I have provided in my resume and this Candidate
Declaration Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I authorize all who may
have information relevant to this enquiry to disclose it to EXOTIC LEARNING and/or its representative. I release all
concerned from any liability on account of such disclosures.
I also declare that the information provided by me in my resume and application for employment at EXOTIC LEARNING
and its representative is authentic and I am liable for all inaccuracies and omissions.
I promise to extend total co-operation and provide relevant documents required.
Full Name of the Candidate: Rahul Kumar Thakur Signature of the Candidate
Place: Kolkata
Date of Joining with EXOTIC LEARNING : 11/12/2021
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