NOIDA

LOCATION: ________________________

Request for ID Card Reset Form

Details to be furnished by the Employee in BLOCK LETTER ONLY

Deepak kumar
Name of the Employee : ----------------------------------------------------------------------------
CONTRACTOR
Employee Type : ---------------------------------------------------------------------------

Employee’s Portal ID Number: ---------------------------------------------------------------------------

Employee’s Synergy ID : ----------------------------------------------------------------------------

B+
Blood Group : ----------------------------------------------------------------------------
8864956174 PARENT
Emergency Contact No : ---------------------------------------------------------------------------

Date of Joining : -----------------------------------------------------------------------------

Click Blank Space To Upload Image Deepak

Glossy Passport Size Photo With Kumar
White Background Only Employees Signature

NO POLAROID PHOTOS PLEASE Signature NOT TO TOUCH THE BOXLINE

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 Contract Employee Personal Details

PASTE YOUR
PHOTO

Personal Information: Click Blank Space To Upload Image

Name Date of Birth Date of Joining

Deepak kumar 02/03/1989

Present Address Permanent Address

754/52 Ekta nagar near shaid bhagat college 754/52 Ekta nagar near shaid bhagat Singh
Meerut. inter college, Meerut

Residence No. Mobile No. 06397150347

Email Id: dpk2542@gmail.com

Marital Status Passport Details

Married Single Self Spouse

If Married Name Date of Birth Passport No Passport No
Spouse Swati Panwar 10/15/1994
Children
Valid upto Valid upto

Date of Marriage 04/26/2018

PAN Card Number Cvxpk7841k

Emergency Contact Details

Name : Dharampal singh Blood Group: Name for mail ID:

Address: Dpk2542@gmail.com
754/52 Ekta nagar near shaid
bhagat Singh inter college,
Meerut (Uttar Pradesh) B+

Contact No: 8864956174

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Family Particulars

Relationship Name of Family Member DOB Age Occupation

Father Dharampal singh 04/17/1959 60 Government job

Mother Rajesh devi 07/15/1966 54 House wife
Spouse Swati Panwar 11/15/1994 24
Sons /
Daughters

Academic and Professional Qualifications

Degree / Marks /
S.No Institution From To
Qualification Position

1 B.Tech Shobhit university 07/01/2007 09/30/2011 6.06 cgpa

2 Intermediate Netaji Subhash inter college 07/01/2006 07/01/2007 72.2%
3 High school Netaji Subhash inter college 08/01/2004 07/31/2005 69.9%
4
5

Employment Details

F. Previous Employment History (In reverse chronological order-latest employment first)

1.Company Name : Arcad Technology India Pvt ltd

Date of Date of
Period of Employment 03/04/2016 11/16/2018
Joining: Relieving:
Organization:

Address: B-3, Sector 2, Noida

Telephone / Fax No: 0120-4328190 Last Salary (CTC): 4.5 Lpa

Position Held: Software Engineer Reporting To: Team lead

Nature of
Responsibility: Worked in development and support in Mainframe.
Reasons for Leaving: Personal reasons

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2. Company Name :
Date of Date of
Period of Employment
Joining: Relieving:
Organization:

Address:

Telephone / Fax No: Last Salary (CTC):

Position Held: Reporting To:

Nature of
Responsibility:

Reasons for Leaving:

3. Company Name :
Date of Date of
Period of Employment
Joining: Relieving:
Organization:

Address:

Telephone / Fax No: Last Salary (CTC):

Position Held: Reporting To:

Nature of
Responsibility:

Reasons for Leaving:

4. Company Name :
Date of Date of
Period of Employment
Joining: Relieving:
Organization:

Address:

Telephone / Fax No: Last Salary (CTC):

Position Held: Reporting To:

Nature of
Responsibility:

Reasons for Leaving:

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 UPLOAD ID CARD (PAN/AADHAR /PASSPORT)

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