joining kit - checklist & declarations

Confidential – July 2011

Checklist for New JoinersPlease update the required details in all the enclosed forms and sign on relevant pages of your Official Polaris

Joining Kit.

First Name Middle Name Surname / Last NameMobile No. Personal Email ID Date of Joining Location of Joining Location of Posting

Ex-Polarite / SGT / Vendor/ Contract regularization? Pls. update details of your earlier/oldPolaris ID No. Polaris Email ID : Designation Function/BSC/GDU

S. No Mandatory Description Status Remarks

1 Interview Evaluation Form / MPR No. details 2 Candidate's Resume & pay slip for fitment 3 ** Signed printed copy of accepted Offer Letter 4 ** Photographs as per requirement

5 ** Service Certificates/ Relieving letter/ Resignation Acceptance letter signed on Company letterhead

6 ** Copy of Passport (first and last page) / Govt. ID proof 7 ** Copy of Educational Certificates (10th, 12th, UG, PG)

8 PAT SCORE sheet for Regularization / ALP documents for GRIP Joiners

9 Confirmation of Joining - Report

10 ** Associate Information Form (AIF) 11 Polaris Vision Form 12 Non Disclosure & Declaration 13 Undertaking Form 14 SDN Check (to be completed and updated by TAG) 15 Affirmation & Compliance Agreement Form 16 Letter of Assurance & ALP Document 17 Deed of Assignment of IPR 18 Information Security Declaration Form / Handbook 19 Group Medical Insurance Declaration 20 Superannuation Nomination Form 21 Polaris Exigency Fund Nomination Form 22 Gratuity Nomination Form 23 PF Nomination Form 24 ESI Form (if applicable) 25 Background Check Report 26 Non Submission of Documents 27 Reimbursement Claim - As part of Recruitment discussion

For HR use Only

Bank Account Opened Associate Hired in Adrenalin IT Request Form issued Temp Id Card Issued Access Card Issued Permanent ID Card Issued Received By Checked by


CONFIRMATION OF JOINING - REPORT From Date :

To HR Head Polaris Software Lab Chennai Dear Sir/Madam

Sub : Joining Confirmation Report

This is to confirm my acceptance of the offer of employment made to me on this day

of 20 at Grade for the position of I have joined Polaris Software Lab on and will proceed to complete all

relevant joining formalities. Thanking you. Yours Sincerely, NAME

Signature

Place


Our Banyan Tree

1. Create the environment to attain personal mastery to push new frontiers2. Unleash the collective knowledge potential3. Achieve global stature by helping customers win in their market place4. Grow the value of Polaris every year5. Anchor the family and its aspirations6. Impact the society at large7. Rooted in Polaris Values – Passion, Humility, Integrity and Respect

Our Values – Foundational

• Passion• Humility• Integrity• Respect• Fun

Phir Fun! (Fun again & again!)

NAME :

DATE :

SIGNATURE :

COPYRIGHT NOTICE

Copyright © 2007 Polaris Software Lab Limited

All rights reserved. These materials are confidential and proprietary to Polaris and no part of these materials should be reproduced, published in any form by any means, electronic or mechanical including photocopy or any information storage or retrieval system nor should the materials be disclosed to third parties without the express written authorization of Polaris Software Lab Limited.


Non-Disclosure and Declaration

This Non Disclosure and Declaration is made on this day ……….............. month of

…………........... year ........................

I …………………………………..son/daughter of Mr.………………………….…………… residing at

………………………………………………………………… State …………………………. Country ………………..,

understand that the intellectual property and customers’ information of Polaris Software Lab

Limited (hereinafter referred to as “Polaris”) are the most important and valuable asset of

Polaris to enable Polaris to achieve its overall business objectives. The protection of this

valuable information is critical to Polaris business. All employees, contract employees,

contractors, project trainees employed on job work or temporary basis or who by his/ her

merit of employment, qualification or trade enters into any of the premises of Polaris should

maintain the highest level of trust in all business relationships and hence are committed to

the terms of this Non Disclosure and Declaration.

1. All information relating to Polaris and its business should be treated in the strictest confidence unless otherwise indicated no information may be disclosed to a third party without the prior express written permission of Polaris,

2. To keep and procure in strict confidence and in safe custody any information, knowledge, data, drawings, know-how and other material (“Information”) communicated by or acquired from meetings, discussions presentations etc. ,

3. to refrain from making copies of documents, mails, forward attachments, download

and transfer, SMS, mobile messaging, blackberry texts any/or form of messaging now known or in the future discovered containing Information or records that are obtained by you from Polaris ,

4. to acquire similar non disclosure and declarations from each employee, agent and director with whom I am interacting in my capacity as a representative of Polaris and assure that each employee observe such restrictions and assure that each such agent or contractor observe such restrictions,

5. not to release any press statement or issue any other publicity regarding the arrangement which may exist or deem to exist that involve Polaris or its business in any manner whatsoever ,


6. not to approach, solicit or conduct business of any kind, directly or indirectly or through any third party any contact centre, client or relationship already established by the other party, this is to include associations whereby business is already being conducted or in negotiation and whereby an introduction has been made by the other party and,

7. that I declare that I am not connected neither am I a member or sympathiser of any declared or undeclared terrorist organisations and ,

8. that the intellectual property and the intellectual property rights for all the work done by me at the time of my employment or contract or assignment in any manner with the company belongs to Polaris perpetually and without any claim from me ,

9. that I have not been charge sheeted for any offence under the Criminal procedure Code (CrPC) and the Indian Penal Code (IPC) or any other criminal laws in India or of any of other country and ,

10. that I am not associated with any money launderer or any business that illegally deals with the movement of money through unlawful means and methods and ,

11. that I have received a copy of Polaris’s Information Security Manual and have read and understood it and,

12. that I am to understand that the entire work that I will be doing for Polaris or at its clients site where I will be deputed will contain cameras and other digital or non digital means of shadowing and copying my work and other activities . I understand that Polaris will be tracking my movements and following my work and capturing information. I agree to allow this monitoring and give consent for the same and also understand that all the information gathered by Polaris during this monitoring can and will be used against me both as evidence before any judicial, quasi judicial, arbitrary authority within the organization. I also state and understand that any third party affected by my illegal actions can initiate legal action against me for just compensation,

13. I agree to be subject to this declaration and disclosure and state that if it is found that I have contravened any of its clauses, I agree that Polaris may terminate my services or the service of my principal without any notice and proceed to seek legal and criminal relief against me and any other beneficiary of my actions and,

14. I am to understand and accept that if my services with Polaris were to be terminated for non compliance of this declaration and non disclosure and if in the opinion Polaris an act of mine has caused loss, I hereby authorise Polaris to forthwith withhold any salary payable to me and to withdraw any shares or concessions offered to me and /or withdraw me from any scheme, salary or perquisite offered to me as an employee/ contractor/ project trainee of Polaris.

15. this non disclosure is perpetual in nature and will continue even after termination of my relationship/Agreement with Polaris and ,


16.upon termination of any agreement that I may have with Polaris, I will not remove any document, tapes , CD , codes, drawings etc pertaining to Polaris from my desk or place of work. An authorized representative of Polaris may request me to destroy all hard and soft copies of the documents in my custody. After the destruction I shall confirm in writing to Polaris that the destruction has been done and no other Information or copies exist under the other parties care or control.

17.That all documents pertaining to the project work executed within Polaris or any document giving information related to Polaris shall be submitted to the reporting department before release of such document/project work/ dissertation and on approval only such document can be published. However Polaris reserves the right to curtail/delete/modify/change any information given in the document.

18. I am aware of the consequences of breach of any of the terms of this Non Disclosure Agreement which may include, immediate termination from services, legal prosecution or any other action which Polaris deems fit to be taken at that point of time.

The Terms of this Non Disclosure and declaration has been explained to me and I have the knowledge of English and have understood the contents of this declaration.

Date : ……………………..

Place : …………………………………………….

Signed as accepted Witness

……………………………….. ………………………….


Compliance Bulletin No: 1/2005Associate Conflicts of Interest Policy

AFFIRMATION AND COMPLIANCE AGREEMENT

I have received a copy and have read and understood the “Associate Conflicts of Interest Policy” and agree to comply with the same. Further I wish to inform you that to the best of my knowledge I am in compliance with all of the provisions of the Policy and have no activities, which could possibly be considered to be a conflict of interest, except as noted below.

Potential Conflicts of Interest:

1) I am not aware of any violation of the Policy by others, except as noted below.*

Violations by Others: 1)….

I further confirm that except as permitted by the Company**:

1) With respect to all transactions in which I have or will participate, I have and will ensure that the same are executed after being previously reviewed by the contract administration or legal department, I am not aware and will not enter into any ancillary, separate or additional letters or agreements, or “side letters” with customers or other third parties (whether written or verbal), creating or confirming any contingent obligations on behalf of the Company or one of its direct or indirect subsidiaries, whether for licenses, services or otherwise, other than as disclosed in this certification or except with prior approval under this Policy.

2) I have not and will not knowingly make payments to, or offers or promises to pay

local or foreign government officials in order to influence their actions in the

Company’s favor.

3) I have not and will not solicit or collect payments due to the Company and deposit

them into a personal account or use them for personal or non-business purposes.

4) I have not and will not solicit or receive payments from a customer, reseller or other party for personal or non-business purposes.

5) I have not and will not interfere with or try to prevent the timely and proper billing of

a customer, reseller or other third party for software licenses, software maintenance

services or other services.


6) I have not and will not knowingly authorize, provide or promise to a customer, reseller or other third party credits or offsets against license or service fees due from such customer, reseller or third party without a justifiable business purpose and proper authorization, other than as disclosed in this certification or except with prior approval under this Policy.

7) I will, for at least 6 months after leaving the Company, not accept directly or indirectly any assignment or employment or engagement with any of the Company’s customer, supplier or business partner or their affiliates, with whom I was or had been engaged with during the preceding 12 months of my leaving the Company.

8) I have accurately identified each transaction that involves a reseller or distributor.

I, further undertake that I will immediately and promptly inform the appropriate authority under the Policy of any incident or engagement or activities which could possibly be considered as Conflict of Interest and is not in conformance with this Policy or of such other Company personnel who commit violations of this Policy.

_________________ _____________________(Signature) (Location)

(Print Name) (Designation)

(Date)

* Note: As an alternative to written identification of violations by others, Employees may call the Corporate Ombudsman (Telephone Number: 0124- 2345588 or 9899222333). * In case any of the statements cannot be confirmed request you to please give

an explanation of which statements you believe cannot be confirmed and why.


[On Rs. 20/- Stamp Paper]

DEED OF ASSIGNMENT OF INTELLECTUAL PROPERTY RIGHTS

This Deed Of Assignment Of Intellectual Property Rights ("Agreement") is made as of the _______, 2011 (the “Effective Date”) by and between POLARIS SOFTWARE LAB LTD., a company incorporated under the Companies Act, 1956, and having its office at No.244, Old No.713, Anna Salai, Chennai – 600 006 (“Polaris”), which expression ‘Polaris’ shall include, subsidiaries and all group companies of Polaris, its successors and assigns, of the ONE PART and

__________________________________ , S/o D/o_____________________________________ __________________________________________, residing at ____________________________, (“Associate”) which expression ‘Associate’ shall include his/her legal heirs, agents, administrators, executors and permitted assigns, of the OTHER PART (each a “Party” and collectively, the “Parties”).

RECITALS

WHEREAS, Polaris is a Company engaged in the business of providing software and other allied services in India and abroad;

WHEREAS, Associate has joined Polaris as an employee of Polaris and will be providing services to Polaris;

WHEREAS, Associate, during the course of this employment with Polaris will create Work Product for Polaris and also for its clients;

AND WHEREAS, the Work Product developed by the Associate are construed to be “Works Made For Hire” (defined hereinafter) under the Copyright Law, and the Associate has agreed with Polaris to assign the Intellectual Property Rights in the Work Product that have been accepted by Polaris in favour of Polaris subject to the following mutually agreed terms and conditions.


NOW, THEREFORE, in consideration of the mutual agreements hereinafter set forth, Polaris and Associate hereby agree as follows:

1. DEFINITIONS

(a) Work Product shall mean the works that has been created by the Associate including all know-how, technical, financial or business designs or data, product strategies, business strategies, architecture, designs, data, flow charts, software, data, methods, or processes that have been developed by the Associate during his employment with Polaris.

(b) Work Made for Hire shall mean the Work Product and/or any other work developed or created by the Associate during the term of his employment with Polaris.

(c) Intellectual Property Rights shall mean any all copyrights, trademarks, moral rights, design rights, rights to know-how, rights in inventions (whether patentable or not) and all other intellectual property rights (whether registered or unregistered and including any form of application for any of the foregoing), and all other equivalent or similar rights that may subsist anywhere in the World which have been acquired, or are in the process of being acquired or capable of being acquired as patents, copyrights, trademarks, designs, trade secrets and other types of intellectual property.

2. In consideration of the monthly salary of Rs. ___________________, paid by Polaris, the receipt and sufficiency of which the Associate hereby admit, acknowledge and confirm, the Associate hereby declares and agrees that the Work Product developed by him/her are “Works made for hire” under the copyright law and other laws governing Intellectual Property Rights, and that Polaris has a perpetual, royalty-free, irrevocable, world-wide and exclusive rights to deal with the Work Product, in any manner whatsoever and in any manner as it deems fit.

3. In consideration of the sums aforesaid, to the extent if by any law or any reason what so ever, any Intellectual Property Rights in the Work Product is deemed to be vested in the Associate and not construed to be “Works made for hire”, the Associate hereby grants, convey, transfer, sell and assign and to the use of, to Polaris perpetually, royalty-free, irrevocable, world-wide and exclusive right in the Intellectual Property Rights in such Intellectual Property Rights in the Work Product, with absolute rights to deal with it in any manner whatsoever as Polaris deems fit, including without limitation to sell, transfer and assign to any person or entity, and that the actions of the Associate as mentioned herein, is with an object that Polaris shall become the owner in the Intellectual Property Rights in the Work Product.

4. The Associate hereby covenant with [__] and agrees as follows:

(a) Notwithstanding any act, deed or thing whatsoever done or executed, performed or knowingly suffered to the contrary, the Associate has good right, full power and authority to grant, convey, transfer, assign and sell the Intellectual Property Rights in the Work Product.

(b) Intellectual Property Rights in the Work Product are free from encumbrances and attachments and that there is no injunction or prohibitory order.


(c) Associate shall hereafter do execute, cooperate and perform any further or other act, deed or thing and writings for securing, acquiring, obtaining, further and better assuring the Intellectual Property Rights in the Work Product and to the use of Polaris, if so as may be reasonably required by Polaris.

(d) Associate shall indemnify Polaris, its directors, employees, officers, agents, assigns and successors-in-interest from and against any liability, damages (both direct and consequential), claims, demands, actions, attorneys cost or any of them arising out of or resulting from a claim, demand or action from a third party intellectual property claim or infringement in the Work Product developed or created by the Associate.

5. This assignment deed shall be governed by the Indian contract act, 1872 and other laws in force in India. All disputes arising under this agreement shall fall within the jurisdiction of the courts at Chennai. Polaris and the Associate may agree to resolve their disputes by arbitration as per the Indian arbitration and conciliation act, 1996.

IN WITNESS WHEREOF the Parties hereto have executed this agreement on the date, month and year first mentioned above.

_________________________ _________________________

Name: Name:Title : Title:

In the presence of Witness: In presence of Witness:

(Signature of Witness) (Signature of Witness)

Name of Witness: ______________________ Name of Witness: ______________________

Son of/Daughter of: ___________________ Son of/Daughter of: _______________________

Address: _____________________________ Address: ________________________________

______________________________________ _______________________________________

______________________________________ _______________________________________

______________________________________ _______________________________________

Occupation: _________________________ Occupation: _____________________________


POLARIS SOFTWARE LAB LIMITEDRegistered Office : “Polaris House”

244, Anna Salai, Chennai – 600 006. India

Undertaking

Having accepted the offer of employment with Polaris Software Lab Ltd., 244, Anna Salai, Chennai – 600 006. India (Polaris), I assure Polaris that:

1. I will abide by its current and future policies and procedures in its entirety. 2. I have not signed any agreement, contract or bond that would disable, prohibit,

restrain me to work for Polaris or its clients.3. I am aware and agree that all documents, correspondences, electronic

communications sent or received by me using any facility of Polaris will belong to Polaris and that the organization has every right to access them at any point in time.

4. I will not misuse or abuse the facilities extended to me by Polaris.5. I shall not directly or indirectly through any person, during the currency of my

employment and for 12 months thereafter, start a business competing with Polaris products and services of which Polaris has exposed me to.

6. In the event of my joining a competing organization, I shall not use/share directly or indirectly, the information relating to Polaris or the contacts I had developed/become aware of during my employment with Polaris or details of Polaris’ clients / prospective clients with whom negotiations are underway.

7. I further undertake to abide by all the laws including the special laws relating to Information Technology, Intellectual Property Rights and such other Data Processing laws of the country, wherever I am posted. I shall get myself acquainted with the laws of the country wherever I am posted and I shall never claim that I was never aware of such laws. I shall not commit any act either directly or indirectly, leading to termination of business relationship with Polaris by any client or prospective client.

8. During the course of my employment, I shall not indulge in immature communication or participate in rumors inside or outside the organization, and am aware of the possible detrimental effect these would have on the peace and image of the organization.

9. I undertake to submit myself to background security investigations about me and on my educational claims and on any statement that I have made that may favourably impacted my being employed / hired for the position in Polaris.

10. In case of breach of this Undertaking either directly or indirectly by me, I agree to keep Polaris indemnified and reimbursed of all loss of profits/opportunities and also reimburse the costs of any law suits including reasonable Attorney fees. I am also aware that mere compensation in monetary terms may not be sufficient to redress Polaris and I agree that Polaris shall always have the right to approach any Indian or foreign courts, as necessary, for legal interventions, remedies, injunctions etc., against me, my future employers and business associates, as deemed appropriate.


11. I undertake to fully co-operate with any authority appointed to inquire into any breach of this Undertaking deed and abide by their decisions.

12. I state that I have signed this undertaking voluntarily after having first read, understood and accepted the contents hereof. I have also taken a copy of this undertaking for my records for the purpose of reference and compliance.

13. I agree that the Company can reduce my monthly salary in the event of any business exigencies or due to my poor performance in delivering the obligations assigned to me.

14. I undertake to keep my future employers and business partners notified of this binding Undertaking Deed I have executed.

15. I will endeavor to take leave only on account of emergencies/exigencies while deputed at onsite locations and client locations.

16. I acknowledge that resignations cannot be rendered during deputation or posting at client / customer or overseas location.



(Date)


EXPORT LICENSING COMPLIANCE - LETTER OF ASSURANCE FOR ASSOCIATES

Date: _________________

Name of the Associate: ______________________

Associate ID: _____________________ Designation: ________________

Unit: _________________

Attn: Export Licensing Coordinator

Re: No Reexport of Controlled Technical Data or Software

During my employment with Polaris Software Lab Ltd (individually and together with its parent, subsidiaries and/or affiliates, “Polaris Group”), I have or will have access to proprietary technical data and computer software. As a foreign national (for U.S. operations; defined as a non-U.S. citizen without U.S. permanent residency status, offshore; non resident of local business country location), I understand that this access constitutes an export of technical data/software from the United States and is therefore governed by the provisions of the U.S. Export Administration Regulations ("EAR").

Consequently, I hereby agree to comply with U.S. Export Administration Regulations as they pertain to any technical data or computer software to which I have access during my Polaris Group employment. Unless prior written authorization is received from the U.S. Department of Commerce or other appropriate agencies, I shall not knowingly reexport, directly or indirectly, this technical data/computer software without full compliance with U.S. export control laws. In particular, I will not export it to any of the following nations or nationals of:

1. Country Group E Cuba, Iran, Libya, North Korea, Sudan, Syria, or

2. Non-civil (i.e., military) end-users or for any non-civil (i.e., military) end uses in Country Groups D: 1 (currently Albania, Armenia, Azerbaijan, Belarus, Bulgaria, China (PRC), Cambodia, Estonia, Georgia, Iraq, Kazakhstan, North Korea, Kyrgyzstan, Laos, Latvia, Lithuania, Macau, Moldova, Mongolia, Romania, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan, and Vietnam.

I will comply with any future modifications of the foregoing list of restricted destinations by amendments to the U.S. Export Administration Regulations or other U.S. Government agencies, which will be posted at http://www.access.gpo.gov/bis/ear/ear_data.html.

http://www.access.gpo.gov/bis/ear/ear_data.html


Without the prior approval of the U.S. Department of Commerce or other appropriate agencies (which shall be sought by Polaris Group if and where appropriate), I shall not knowingly export to any of the above nations, directly or indirectly, any product (or any part thereof), process or service which is the direct product of this technical data/computer software.

Additionally, I understand that countries other than the U.S. may restrict the import or use of strong encryption products and export of any products, and I will comply with any such restrictions. In the event that I have questions about any such restrictions, I will contact a Polaris Group Export License Coordinator.

I understand that my failure to comply with the requirements and restrictions set forth in this letter may expose me and Polaris Group to severe criminal and administrative penalties and sanctions. In addition, I will be subject to disciplinary action up to and including immediate termination of my Polaris Group employment.

By signing below I agree to comply with the requirements and restrictions set forth in this letter, which agreement I understand is a condition to my having access to proprietary technical data and/or computer software during my Polaris Group employment.

Sincerely,

Signature

Name:


Information Security - Associate Declaration Form

Name: ___________________________________

Employee ID ___________________________________

DOJ: ___________________________________(Date of Joining)

With respect to M/s. Polaris Software Lab Limited (“Polaris”) providing access to me to its information assets or to that of its clients or group companies, for carrying out my obligations, I, the undersigned, hereby make the following declaration:

1. I confirm that I have read and fully understood “Information Security – User Handbook” and the policies and procedures of Polaris concerning information security and shall confirm to the same during the period of my employment with Polaris.

2. I undertake to read and understand the information security training material(s) and complete the ISMS Certification exam within one month of my joining Polaris.

3. I agree to review and abide by the information security policies of the client(s) of Polaris while providing services to the client(s) of Polaris.

4. I agree that Polaris may take any disciplinary action against me in the event of me violating any of the information security policies and procedures of Polaris or its group companies or that of its client(s).



(Date)


Form of Appointment of Beneficiary under the rules of Polaris Software Lab Limited

Group Medical Coverage

ToMediclaim TeamPolaris Software Lab Ltd (Group Medical and Personal Accident Insurance Coverage)Chennai 600006.

* Please individually mention the relationship of your Nominees with you. Do provide correct and full details regarding their names and date of birth (applicable age 0 – 75 yrs).

SL# Name of Beneficiary Age Relationship DOB(DD/MM/YY)

1

2

3

1. Your Eligible *nominees can be your Spouse, Children and Parents

2. Female Associates can nominate their in laws (cannot give mixed nominations of In- laws and Parents)

3. For T1XX associates dependents insurance coverage starts after one year of completion from DOJ

4. In case of any queries please write to [email protected]

5. The Policy and Other details about GMC is loaded in Empower-Reachout-Facilities- Medical Insurance presentation

6. The nominations cannot be changed for one year till next policy renewal, except in case of circumstances around birth/death/marriage

7. Please contact your Unit HR or [email protected] during these circumstances

_________________ _____________________(Signature)

DATE

(Print Name) Location

Name :Associate ID :

DOJ :Location :


Form of Appointment of Beneficiary under the rules of Polaris Software Lab Limited

Superannuation Scheme

ToThe TrusteesPolaris Software Lab Ltd Superannuation SchemeChennai 600006.

I, _________________________________________________ a member of Polaris

Software Lab Limited Superannuation Scheme, hereby appoint in terms of the Rules headed

‘APPOINTMENT OF BENEFICIARY’, governing the Scheme my (relationship*)

________________ (Name) ________________________ aged ________ years and

whose address is __________________________________ _____________ State

_________________PIN _____________ as the person to whom the moneys payable

under the rules of the Scheme shall be paid in the event of my death.

Signed at _______________ this ________ day of ________ 20___====================================================

WITNESSED BY Signature of the Member

Signature (1) ___________________ (2) ____________________

Name ___________________ _____________________

S/o ___________________ _____________________

Address ___________________ _____________________

___________________ ____________________

*In case of Appointment of more than one beneficiary, please mention individually their relationship with you, their names, age and address and the percentage of proceeds payable to each of them below.

SL# Name of Beneficiary

Age Relationship DOB(DD/MM/YY)

% of Proceeds

1

2

3


Form of Appointment of Beneficiary under the rules of

Polaris EXIGENCY FUND

ToThe TrusteesPolaris Exigency FundChennai 600006.

I, _________________________________________________ a member of Polaris

Exigency Fund, hereby appoint in terms of the Rules headed ‘APPOINTMENT OF

BENEFICIARY’ in the Rules governing the Fund my (relationship*) ________________

(Name) ________________________ aged ________ years and whose address is

__________________________________ _____________ State _________________PIN

_____________ as the person to whom the moneys payable under the rules of the Scheme

shall be paid in the event of my death.

Signed at _______________ this ________ day of ________ 20___====================================================

WITNESSED BY Signature of the Member

Signature (1) ___________________ (2) ____________________

Name ___________________ _____________________

S/o ___________________ _____________________

Address ___________________ _____________________

___________________ ____________________

*In case of Appointment of more than one beneficiary, please mention individually their relationship with you, their names, age and address and the percentage of proceeds payable to each of them below.

SL# Name of Beneficiary

Age Relationship DOB(DD/MM/YY)

% of Proceeds

1

2

3


THE PAYMENT OF GRATUITY (CENTRAL) RULES, 1972FORM 'F'

[See sub-rule (1) of rule 6]

Nomination

To …………………………………………………………………………………………………………………………………………………

[Give here name or description of the establishment with full address]

I. Shri/Shrimati/Kumarim …………..………………whose particulars are given in the statement below,

[Name in full here]

hereby nominate the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity standing to my credit in the event of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against the name(s) of the nominee(s).

2. I hereby certify that the person(s) mentioned is a/are member(s) of my family within the meaning of clause (h) of section (2) of the Payment of Gratuity Act, 1972.

3. I hereby declare that I have no family within the meaning of clause (h) of section (2) of the said Act.

4. (a) My father/mother/parents is/are not dependent on me.

(b) my husband's father/mother/parents is/are not dependent on my husband.

5. I have excluded my husband from my family by a notice dated the ………………… to the Controlling Authority in terms of the proviso to clause (h) of section 2 of the said Act.

6. Nomination made herein invalidates my previous nomination.

Nominee(s)

Name in full with full address of nominee(s)

Relationship with the employee

Age of nominee Proportion by which the gratuity will be

shared

1.

2.

3.

4.

5.


STATEMENT

1 Name of employee in full.

2. Sex.

3. Religion.

4 Whether unmarried/married/widow/widower.

5. Department/Branch/Section where employed.

6. Post held with Ticket or Serial No., if any.

7. Date of appointment.

8. Permanent address.

Village …………………… Thana ……………………… Sub-division …………… Post Office ………………

District …………………… State…………………………

Place

Date

Signature/Thumb impression of the employee

DECLARATION BY WITNESSES

Nomination signed/thumb impressed before me.

Name in full and full address of witnesses. Signature of witnesses.

1. 1

2. 2.

Place Date

CERTIFICATE BY THE EMPLOYER

Certified that the particulars of the above nomination have been verified and recorded in this establishment.

Employer's Reference No., if any.

Name and address of the establishment or rubber stampthereof.

Signature of the employer/Officer authorized

Date Designation

Acknowledged by the employee

Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.

Date Signature of the employee


DATE :

PLACE :FROM(Name & Full Address)___________________________

___________________________

___________________________

ToHead of Talent AcquisitionPolaris Software Lab Ltd.

Sub : UNDER TAKING OF NON-SUBMISSION OF DOCUMENTS

Sir/Madam

I, _________________________________, would like to bring to your notice that I have not submitted the following documents.

1) ___________________________________________________

2) ___________________________________________________

3) ___________________________________________________

4) ___________________________________________________

5) ___________________________________________________

6) ___________________________________________________

And I assure you that I will submit the above said documents by (date)

______________________. Please permit me the time to submit the documents.

Your Sincerely

(Signature)


Declaration for Reimbursements part of Recruitment Process

• To claim the reimbursement amount mentioned to you within 30 days from Date of Joining, after

which the candidate is not eligible to reimburse the amount.

• Associates wishing to reimburse must give the necessary documents. Reimbursements will only

be made on the submission of original invoices and/or receipts to the satisfaction of the Finance

Department.

Please note - This is a discretionary payment subject to negotiation at interview and commitment given by the Recruiter.

I hereby acknowledge that I have read the document “Declaration for Reimbursements” and confirm that I understand the content and agree to abide by the Underlying Principles thereof.

________________________________ ____________________(Associate Signature) Date

Name

BSC

Reporting Manager

DOJ

Sl.No. Head Amount Justification

TOTAL