Background Verification Form
Note: All information should be filled in CAPITAL LETTERS only.
Contractor/Principal Employer
Work Location Profile /
Department
Date of placement at Infosys Employee ID
PERSONAL DETAILS
Name of Applicant
First
Middle
Last
Maiden Name:
Have you ever been known by another name? Yes/No -
If Yes, please write the other name:
Place of Birth: Date of Birth (dd/mm/yyyy):
Gender: Nationality:
Father’s Name Passport Number PAN (Permanent account Number)
Home Phone Office Phone Mobile
RESIDENTIAL ADDRESSES
Permanent Address:
Nearest Landmark:
Contact person name and number:
City State
Pin Phone No.
Residing Since (mm/yyyy) -
Residing till (mm/yyyy) – Type of residence: Rented/Owned/Others
*If currently residing at the same address, please mention “till
date” under residing till
Current Address:
Nearest Landmark:
Contact person name and number:
City State
Pin Phone No.
Residing Since (mm/yyyy) - Type of residence: Rented/Owned/Others
Residing till (mm/yyyy) –
*If currently residing at the same address, please mention “till
date” under residing till
Please confirm on the document submitted as Proof (Mandatorily require copy of ANY ONE document for each address):-
For Current address
Electricity/Phone Bill Ration Card Passport Copy Voter ID Driving License Aadhaar card
If any other document please clarify (should be issued by Indian government)
For Permanent address
Electricity/Phone Bill Ration Card Passport Copy Voter ID Driving License Aadhaar card
If any other document please clarify (should be issued by Indian government)
For Name change (if any)
Gazette Marriage Certificate Affidavit
For office (Infosys) use only
Address to be considered for Criminal verification: Current Permanent
Address to be considered for Address verification: Current Permanent
Please tick () appropriate requirement
Information Release Form
To Whom It May Concern:
Please print
I ,
Last name First name Middle name
hereby authorize (Company name) , being my employer
Infosys Limited where I am deputed by (Company and and
name) their
respective representatives to verify information presented on my employment
application/resume and to procure an investigative report or consumer report for that purpose.
I hereby grant authority for the bearer of this letter to access or be provided with full details:
pertaining to information in respect to my character from the records maintained
by local authorities
to verify address shared
of my qualification/degree (copy of my certificates attached)
of my previous employment record held by any company or business for whom
I previously worked. This information should include the dates of employment;
the nature of the position held, [details of my salary upon departure] and an appraisal of
my performance, capabilities and character
pertaining to any other pertinent information requested by the individual
presenting this authority.
I hereby release from liability all persons or entities requesting or supplying such information.
Signature: Date: dd / mm / yyyy
