BACKGROUND VERIFICATION FORM (to be filled by Candidate)

(Confidential when filled)

ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purpose only. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as
proof for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in
the rejection of your offer/termination of employment and action being taken as per the company policy.

Important: Candidate is requested to ensure all documents submitted as proof are Self-Attested stating Date & Purpose. [State purpose
as ‘employment’]. Attestation should be done along the edge of the document ensuring no key areas of the document are overwritten. This
is in your own interest.

Self-attestation ensures your documents are only used for the purpose they are meant for and unauthorized use is dissuaded.

HOW TO COMPLETE THE FORM

STEP 1 You may need 15 – 20 minutes to complete the form.
STEP 2 Do read all the instructions very carefully. They contain important information about how to complete the application in every
respect and the documents that can be submitted as evidence (the information furnished by you would be incomplete without
documentary proofs).
STEP 3 Fill the form in BLOCK LETTERS with a BLACK ball point pen ONLY.
STEP 4 Sign the “Authorization Release Note” provided at the end.

Client Reference Number :

PERSONAL DETAILS

1. Name :

First Name Middle Name Last Name Please affix a

2. Father’s Name Passport size
photograph here and
First Name Middle Name Last Name sign across.
3. Alias Name
First Name Middle Name Last Name
4. Date of Birth 5. Place of Birth 6. Gender 7. Marital Status
Town :
Single
Female
City :
D D M M Y Y Y Y Married
Male
Country :

8. Nationality

9. Contact Details:

STD/ ISD Code Phone(Residence)

Mobile Number: Alternate No.

Confidential ARS/BE-Prod/FR/43 Ver 1.9

 Mail ID

10. Others

PAN No.(Enclose Copy)

Passport No.(Enclose Copy)

SSN/SIN/EIN No. if applicable

11. Are any criminal/civil proceedings pending against you before a court in India? If so, give name of court, case number and relevant
sections of Law.

12. List of Enclosures – Proof of Identity (Kindly tick (√) the relevent box below)
Passport Voter ID Card PAN Card Driving License Others(Specify)

ADDRESS DETAILS
( Enclose a valid address proof of the address mentioned below
Please use a Photocopy of this sheet for Multiple Addresses)
ATTENTION: The information you provide in the Background Verification Form (BVF) must be accurate as the same will be used for
verification purpose only. Therefore, you are advised to fill the entire BVF with utmost care and attention. Documents provided as
proof for the details in the BVF should match. Any mismatch of information/ documents or providing false information may result in
the rejection of your offer/termination of employment and action being taken as per the company policy.

INSTRUCTIONS
1. Fill in the complete POSTAL Address. All fields are mandatory. Wherever not applicable, please write “NA”.
2. Keep your family members/ neighbors aware of the impending visit for address verification.
3. Duration of stay mentioned as ‘Till Date’ will be considered as date of signing the form.
4. During verification, if it is validated that you were not residing at the address on the duration mentioned, Verification would be
declared as NEGATIVE.

1. Address Type 2. Residence Type 3. Best day to visit 4. Best Time to visit
(Mon –Sat)

Permanent Owned Hostel/ PG Rental

With Relative Parental

5.1 PERMANENT ADDRESS

Line 1
Line 2
Line 3
City District
State PIN Code

Confidential ARS/BE-Prod/FR/43 Ver 1.9

Nearest Landmark
Period of Stay

6. If you are staying in a Hostel/ PG/ Rented House, kindly provide the Name and Contact Details of your Landlord/ Owner/ Warden:

7. State clearly, if the entry is restricted or security Guard/RWA Society etc., is to be contacted for verification of the address provided.

5.List of Enclosures: Proof of address mentioned above (Kindly tick (√) the relevent box below).
Passport Voter ID Card Driving Licence Latest Phone Bill Latest Electricity Bill

1. Address Type 2. Residence Type 3. Best day to visit (Mon –Sat) 4. Best Time to visit

Current Owned Hostel/ PG Rental

With Relative Parental

5.2 CURRENT ADDRESS
Line 1
Line 2
Line 3
City District
State PIN Code

Nearest Landmark
Period of Stay

6. If you are staying in a Hostel/ PG/ Rented House, kindly provide the Name and Contact Details of your Landlord/ Owner/ Warden:

7. State clearly, if the entry is restricted or security Guard/RWA Society etc., is to be contacted for verification of the address provided.

5.List of Enclosure: Proof of address mentioned above (Kindly tick (√) the relevent box below).
Passport Voter ID Card Driving Licence Latest Phone Bill Latest Electricity Bill

Please note that AuthBridge will be conducting your employment background verification on behalf of your employer. Given below is the
Authorization letter, where you need to sign to authorize for your background verification. You have right to deny and not sign the
Authorization letter if you do not want to allow for verification. You are also required to go through our Privacy Policy on
https://ibridge.authbridge.com/home/privacy-policy

Confidential ARS/BE-Prod/FR/43 Ver 1.9

 AUTHORIZATION NOTE

Confidential ARS/BE-Prod/FR/43 Ver 1.9

 ‘To whom so ever it may concern’

I authorize the Employer, AuthBridge and its associated third parties to collect, process, store, use, transfer, maintain my Personal data,
sensitive Personal data (if required for verification) in order to obtain employment verification report in connection to my application for
employment

The employment verification report may include information regarding my character, reputation, personal characteristics, Education
(Authentication of acquired or pursuing Degrees/Diplomas); Employment history; Credit history; court records, including criminal
verification records as permitted by law; National Identity Verification; Drug Test; Finger Print Verification; Address Verification ,references
from professional and personal associates as maybe applicable and any other check as found relevant for the profile.

I, further understand and agree that the employment verification report may be obtained at any time and any number of times as
necessary before, during or post my employment.

I understand that some or all the information I have provided in this application form will be held as digitized or physical records as per
the data retention period, contractually agreed between the employer and AuthBridge.

I hereby authorize my all previous employers, educational institutions, consumer reporting agencies and other persons or entities having
information about me to provide such information to the employer, AuthBridge and its associated third parties for the verification purpose.

I understand that the continuance of the employment or the offer of employment is contingent upon the outcome of the background
check conducted on me.

The proof of Identity enclosed and self-attested for reference. A Photostat, or any other copy, of this instrument bearing my signature
shall be equally legally valid as the original.

Note: 1. It is mandatory to duly sign the form on the space provided below or else the application form would be rejected.

2. If you are an EU (European Union) subject, you have the right to withdraw consent for processing of your Personal Data at any time by contact -
ing your employer/ organization initiating your Background verification. You also have further rights with respect to your Personal Data pro -
cessing, subject to conditions and restrictions set out in the applicable laws. To know more about EU data subject rights please visit
https://ibridge.authbridge.com/home/privacy-policy.

I have read and agree to the Privacy Policy.

Signature: ________________

Name: ___________________

Date: ____________________

Place: ____________________

Confidential ARS/BE-Prod/FR/43 Ver 1.9