SUMANDEEP VIDYAPEETH

(An Institution Deemed to be University Under Section 3 of UGC Act,1956)

At. & Post : Piparia, Ta : Waghodia,
Dist : Vadodara-391760

SV/ADM/HR/2018-19

EMPLOYEE - I CARD APPLICATION FORM

Institution/ Section/ Department: ___________________________________

Name: ________________ ___________________ _______________________

(Name) (Middle Name) (Surname)

Date of Birth: ____/___/______ Gender :____________________(Male /Female)

Blood Group:_____________________________________________

Emergency Contact Number: ___________________________________

Employee Designation: ____________________________________

(Teaching /Non teaching): ____________________________________

Date of Joining: ____________________________________

Experience: _____________________________________

Residential Address: ___________ _________________________

_____________________________________

_____________________________________

Pin Code: - _____________________________________

Mobile No: - _____________________________________

Email .ID. _____________________________________

Remarks: _____________________________________

______________________________________
Employee Declaration :-

I Declare that the information on this form is true and is correct and that I can produce
documentation to verify if required .

Note:

1. I Card must be return to HR section before getting relieving.

2. Report loss of card immediate report to HR section.
3. Duplicate Card will be reissued against fresh application along with Rs. 200/- for non teaching and
RS.400/- for teaching.

Enclosed Document :-

1. Photocopy of appointment order or joining letter.

2. ID-Proof (Ex.- Election card, Pan card, Adhaar Card)

Date : ________________________

______________________________ _______________________________
Signature of Staff Signature of HOD /HOS

Name :________________________ Name :________________________

Official College Stamp :____________

For University Use :

1. Accepted /not Accepted for further processing

Reason for not accepting :_______________________________________________________

2. Date of Issue of I- Card :

_______________________________________________________

Signature Of Staff as received.