NAV Backoffice
Personal Data Form last Ten years
To
Applicant No/Employee ID Location Date of Joining/Interview
Please affix
Designation Bank Account No PAN No
recent
Photograph
Address State Country Zip Code
I. PERSONAL DETAILS:
NAME: _______ANKITA SHARMA_______________________________
DATE OF BIRTH: _______08-08-1998______________ PLACE OF BIRTH:___JAIPUR____
NATIONALITY: ______INDIAN__________ RELIGION:___AS PER ETHNICITY__
E-MAIL ID: ________________ankita.sharma@gmail.com________________
BLOOD GROUP: _____________A+_____________
HEIGHT: _____167cm____________________________ WEIGHT: __85 Kg_______
FATHER’S NAME: Shri __MOHAN LAL SHARMA_____________
FATHER’S QUALIFICATION & OCCUPATION: ____________BUSINESS_________
MOTHER’S NAME: Smt.___SHOBHNA SHARMA__________________________
MOTHER’S QUALIFICATION & OCCUPATION: ______SERVICE________________
PRESENT ADDRESS: ____HOUSE/ FLAT/PLOT NO.,STREET/AREA, CITY, STATE-PIN CODE
PERMANENT ADDRESS: ______SHOULD BE AS PER AADHAR_____________
Do you stay in Own/Rented House? _OWNED________________ Since when
____2011_____
EMERGENCY CONTACT NO(Family Member) : ______9000006789___MOBILE No__8000095555
MARITAL STATUS: (Married/Single) __MARRIED_____________________________
If married: WEDDING ANNIVERSARY: ______11/01/2020____________________
NAME OF SPOUSE: _RAJ SHARMA_ QUALIFICATION OF SPOUSE:_____CA
DETAILS OF HIS/HER EMPLOYMENT: ___PRIVATE SERVICE___________
Address History (List most recent first) – Please provide addresses for the last ten years
Period of Stay
Address State Country Zip Code Contact No
From To
2010 RAJ. INDIA 302011 8000095555
2021 HOUSE/
FLAT/PLOT
NO.,STREET/AREA,
CITY
Page 1 of 6
Educational Qualification (Starting from Secondary)
Dates Attended Year Of
Standard School/College Name Board/University Percentage
From To Passing
10TH ST. TERESSA 2011 2012 CBSE 2012 75
CBSE 80
TH
12 ST. TERESSA 2013 2014 2014
B.COM COMMERCE RAJASTHAN 2017
65
COLLEGE 2014 2017 UNIVERSITY
M.COM COMMERCE 2019 RAJASTHAN 2019
60
COLLEGE 2017 UNIVERSITY
Professional Certification -
Dates Attended Type of Qualification
Course Institute Name ID/Roll No
From To Certification Gained
CA/CS ICAI 2018 2021 CA 231654156
Subject Major
Full Time
Part Time
Please tick mark the documents submitted for this qualification along with this form
Marksheet Provisional Certificate Degree Certificate None
Family Details (Other than those mentioned above)
S.No Name Age Occupation Relationship
1 ARIANA 1 YEAR NA DAUGHTER
Page 2 of 6
Employment History (List most recent first and covering last 2 employers)- Last Employer
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your
Name of Last Employer: SURESH SHARMA Address of Last Employer: SSC LTD., MUMBAI
Telephone 0141-2525424 Employee Code/No 1001 Designation Department ACCOUNTING
MANAGEMENT TRAINEE
Employment Period Manager’s Name XYZ Manager’s Contact No 9999999999 Can a reference
taken now?
From 2019 To2021 Manager’s Email Id Yes
manager@gmail.com No
Duties & Responsibilities gdjgjhfhdsfhd Reason for leaving FURTHER GROWTH
First Salary Drawn 30000 Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn 37000 Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify) PAYSLIP
None
Previous Employment History (Last 2 employers)- Please attach a copy of your relieving letter/service certificate
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your
Name of Employer (1): NA Address of Employer:
Telephone Employee Code/No Designation Department
Employment Period Manager’s Name Manager’s Contact No Can a reference
taken now?
From To Manager’s Email Id Yes
No
Duties & Responsibilities Reason for leaving
First Salary Drawn Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify)
None
Previous Employment History (Last 2 employers)- Please attach a copy of your relieving letter/service certificate
Note: Ensure that you are descriptive wherever necessary- eg. If co. is closed, do mention it. Employee Code/Id/Number
Page 3 of 6
is mandatory. If your previous employer did not provide one, Please mention and state reasons for the same your t
Name of Employer (2): NA Address of Employer:
Telephone Employee Code/No Designation Department
Employment Period Manager’s Name Manager’s Contact No Can a reference
taken now?
From To Manager’s Email Id Yes
No
Duties & Responsibilities Reason for leaving
First Salary Drawn Was this Position Agency Details (if temporary or Contractual), provide details
Permanent
Second Salary Drawn Temporary
Contractual
Please tick mark the documents submitted for this employment
Service Certificate Relieving Letter Offer letter Any Other (please specify)
None
II. GENERAL INFORMATION:
Please give details of significant achievements in your career.
_______________________NA____________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Details of scholarship/awards (if any):
____________NA_______________________________________________________________
___________________________________________________________________________
Please give details of the vehicle you would be using for commutation:
TYPE OF VEHICLE MAKE REGISTRATION No.
(Two /Four-wheeler)
a) ________TWO___________ _ACTIVA(2015)__ _________RJ 14 BE1212________
b) _______________________ _________________ _________________
List your hobbies and pastime activities: ______________READING BOOKS, ETC._____
___________________________________________________________________________
Have you ever been arrested / summoned by court? If yes, give details.
_______________NA____________________________________________________________
___________________________________________________________________________
Do you hold a valid passport? If yes, then mention your passport number here under
________________________NA___________________________________________________
References (Person should hold responsible position and should not be a relative
Page 4 of 6
S.No Name Address Occupation Contact No
1 RAJAT SSC LTD., MUMBAI Sr. MANAGER
KAPOOR
9999999999
9000000000
2 SHEFALI NSE LTD., JAIPUR MANAGER
VERMA
9888888888
3 RIA SINGH BSE LTD., MUMBAI CA
Please account for any and all gaps in education or employment during your tenure
From NA To Reason:
Complete Address & Location:
From To Reason:
Complete Address & Location:
From To Reason:
Complete Address & Location:
Documents Required:
Education:
Photocopy of degree certificate and final marksheet
Employment
Photocopy of relieving/experience letter
Criminal Verification: Rest of India except Tamil Nadu, Andhra Pradesh and Karnataka
Three (3) passport size photographs
The passport Copy, election Id, Driving License or copy of attested photo passbook is mandatory,
irrespective of the address
If the current address corresponds to the one in these documents, then no other documents are required.
If not corresponding to the current address then the following will have to be provide, in order of priority
a) Utility bills-MTNL or BSES bills stating current address (can not be accepted in rural areas)
b) A copy of the Lease agreement (Rural & Urban)
c) If staying at Company accommodation then Letter from Company is required stating the same.
d) If living with relative/friend, then the agreement copy of the residence and the letter stating the relationship with the concerned
relative/friend. Can submit a letter on the society letterhead as well. (original copy would be required)
e) Completed CID Form (filled in Blue ink)
Criminal Verification: for Rural Areas
Three (3) passport size photographs
For address proof only ration card, purchase agreement, attested leave and license agreement (duly attested by society secretary or
gazetted officer/SEO) or letter on society letterhead stating subjects stay at the given address duly stamped and signed by society
secretary or chairman.
As is the procedure followed by most police departments across India for criminal background verification, it is possible that police authorities
may contact you or visit your stated residence and at times even ask you to present yourself at the concerned police station. It is part of the
standard verification procedure. Please do not give in to any attempts at coercion by the authorities and in the event of an occurrence.
Note: Your Data can be shared with 3rd party i.e government or private agencies as per the business or legal requirements.
Declaration and Authorization
Page 5 of 6
I hereby authorize NAV Back office (or a third party agent appointed by Company) to contact any former employers as indicated above and carry
out the Background Checks not restricted to education and employment deemed appropriate through this selection procedure. I authorize former
employers, agencies, education institutes etc to release any information pertaining to my employment/education and I release them from any
liability in doing so.
I certify that the above statements are correct and complete to best of my knowledge and belief and nothing has been concealed. I am not aware of
any circumstances which might impair my fitness for employment. If at any time, I am found to have concealed any material information or given
any false details, my appointment should be liable for termination without any notice or compensation and Company is free to take any legal
actions.
Place: ____JAIPUR_________ Signature: _____ankita__
Date: ___DATE OF JOINING__________ Name: _______ANKITA
SHARMA______
Page 6 of 6
