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Coc Application Form To Be Signed and Uploaded in The International Workers Portal. Date 30-Apr-24-03-40-02 Page 1

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228 views1 page

Coc Application Form To Be Signed and Uploaded in The International Workers Portal. Date 30-Apr-24-03-40-02 Page 1

teo hhuj hhjj hhjgd hhhhhgff

Uploaded by

rockyece123
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© © All Rights Reserved
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EMPLOYEES' PROVIDENT FUND ORGANISATION ,INDIA

APPLICATION FOR OBTAINING CERTIFICATE OF COVERAGE


(To BE FILLED IN BLOCK LETTERS ONLY ) REFERENCE No. 31030042400006632014

DETAILS OF THE EMPLOYEE:


NAME:SANGHAMITRA SARKAR DATE OF BIRTH: 14/01/1990

GENDER: FEMALE NATIONALITY: INDIAN

UAN: 100332351838 AADHAAR NUMBER: 497626690436

PERMANENT ADDRESS: EMAIL ID /CONTACT PHONE NUMBER:


5B,BG-32,HARI ABASAN PH-2,HANAPARA, KRISHNAPUR, sanghamitra.sarkar@tcs.com
NORTH 24 PARGANAS, PIN - 700102, WEST BENGAL , INDIA 9874548490
NORTH TWENTY FOUR PARGANAS KOLKATA WEST BENGAL

PASSPORT DETAILS:(Copy of passport to be enclosed)


PASSPORT NUMBER:U3915949 DATE OF ISSUE: 09/12/2020

PLACE OF ISSUE: KOLKATA VALID UPTO: 08/12/2030

FAMILY MEMBERS ACCOMPANYING THE EMPLOYEE : NO


DETAILS OF THE PRESENT EMPLOYER IN INDIA:
ESTABLISHMENT NAME: TATA CONSULTANCY SERVICES LIMITED ESTABLISHMENT PF CODE NO: MHBAN0048475000

ESTABLISHMENT ADDRESS: EMAIL ID /CONTACT PHONE NUMBER:


11TH FLOOR, AIR INDIA BUILDING, NARIMAN POINT, corporate.socialsecurity@tcs.com
MUMBAI CITY, MUMBAI, MAHARASHTRA, 400021

BUSINESS ACTIVITY(INDUSTRY/TRADE SERVICE): INDUSTRY

COUNTRY (HAVING SOCIAL SECURITY AGREEMENT WITH INDIA) WHERE CANADA


EMPLOYEE IS GOING TO WORK

WORK PERMIT DETAILS FROM(DD/MM/YYYY): 21/04/2024

TO(DD/MM/YYYY) : 17/09/2024

DETAILS OF THE EMPLOYER & PLACE OF WORK IN COUNTRY (HAVING SOCIAL SECURITY AGREEMENT
WITH INDIA) WHERE GOING TO WORK :
NAME(S) AND ADDRESS OF FIRM/ESTABLISHMENT/SHIP: EMAIL ID /CONTACT PHONE NUMBER:
TATA CONSULTANCY SERVICES CANADA INC. corporate.socialsecurity@tcs.com
400 UNIVERSITY AVE.25THFLOOR,TORONTO,ONTARIO,M5G 2263716307
1S5

BUSINESS ACTIVITY(INDUSTRY/TRADE SERVICE): INDUSTRY

Joint undertaking by the employer and employee:


We hereby undertake that :
The employer shall continue to contribute in respect of this employee in India during the period of posting abroad during
which time the employer-employee reletionship shall be maintained. The employer shall inform EPFO about any change
in the employment status/secondment of the posted employee during the currency of this certificate. The Employee
shall inform EPFO,about any loss/theft of this Certificate. The Employee and Employer shall be jointly and separately
responsible for the misuse of any kind, of the Certificate of Coverage, If any.

............................................. ..............................................................
Signature of Employee with Date Signature of Employer with Date and Stamp

COC APPLICATION FORM TO BE SIGNED AND UPLOADED IN THE INTERNATIONAL WORKERS PORTAL. Date 30-Apr-24-03-40-02 page 1

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