Background Verification Form

Instructions: Please fill the form in BLOCK letters only and do not use any abbreviations
Fields Marked in (*) is mandatory.

Personal Information
*First Name
*Middle Name
*Last Name
Former/Maiden Name
*Nationality
*Gender ☐ Male ☐ Female ☐ Others
*Marital Status ☐ Single ☐ Married ☐ Others : ____________
D D M M Y Y Y Y
*Date of Birth
*Father’s Name
*Personal Contact No.
*Identification Type * Identification No.
(Passport / PAN Card / Driving (Passport / PAN Card / Driving
License / Voter’s Card ) License / Voter’s Card)

National Identity No./

Social Security No.
(If Applicable for Overseas
location)

Current Address
*House / Flat Number
*Building Number & Name
Address Line 1
Address Line 2
Address Line 3
*City *Postal/ Zip Code
*State *Country
*Prominent Landmark
D D M M Y Y Y Y
*Period of From
Stay To D D M M Y Y Y Y

*Personal Contact No.

Confidential
 Permanent Address
Same As Above ☐ YES ☐ NO
*House / Flat Number
*Building Number & Name
Address Line 1
Address Line 2
Address Line 3
*City *Postal Code
*State *Country
*Prominent Landmark
D D M M Y Y Y Y
*Period of From
Stay To D D M M Y Y Y Y

*Personal Contact No.

Education Section
Instructions: Fields Marked in (*) is mandatory.

HIGHEST - Qualification 1
*Name of Qualification Obtained
* School/ College/Institute - Name
*School/ College/Institute - Location
School/ College/Institute - Contact No
*University / Board - Name
*University / Board - Location
Enrolment / Roll / Registration
Number
M M Y Y
From
*Period of Study M M Y Y
To
*Year of Passing *Graduated ☐ Yes ☐ No ☐ Pursuing
☐ Regular / Full Time ☐ Part Time ☐
*Course Attended
Correspondence
☐ Final Year Mark-sheet ☐Degree Certificate (Along with backside if
any)

*Documents Submitted ☐ Provisional Certificate ☐ Consolidated Marksheet

☐ Other -: ________________

Confidential
 Qualification 2
*Name of Qualification Obtained
* School/ College/Institute - Name
*School/ College/Institute - Location
School/ College/Institute - Contact No
*University / Board - Name
*University / Board - Location
Enrolment / Roll / Registration
Number
M M Y Y
From
*Period of Study M M Y Y
To
*Year of Passing *Graduated ☐ Yes ☐ No ☐ Pursuing
☐ Regular / Full Time ☐ Part Time ☐
*Course Attended
Correspondence
☐Final Year Mark-sheet ☐Degree Certificate (Along with backside if any)

*Documents Submitted ☐ Provisional Certificate ☐ Consolidated Marksheet

☐ Other -: ________________

Employment Section
Note: Please start with your most recent employer
Instructions: Fields Marked in (*) is mandatory.

Employer 1
*Company Name
☐ Company/Operation Closed ☐ Functional ☐ Re-located
Company Current Status
☐ Merged with

Company also Known as

*Complete Company
Address with Landmark
(Where candidate has worked)

* Company Contact No.

*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
*Supervisor’s Contact No.
Department *Supervisor’s Email ID

Confidential
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit

Reason for Leaving:

*Employment Type ☐ Full - Time ☐ Part-Time

☐ Probation ☐ Permanent ☐ Contractual ☐
*Nature of Employment
Temporary
☐ Reliving Letter ☐ Experience Letter ☐ Service Letter ☐ Pay Slip
*Documents submitted
☐ Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

Can we contact HR /
Supervisor now (Y/N) if ☐ Yes ☐ No ☐ Date:_________
No, then date:-

Employer 2
*Company Name

☐ Company/Operation Closed ☐ Functional ☐ Re-located

Company Current Status
☐ Merged with

Company also Known as

*Complete Company
Address with Landmark
(Where candidate has worked)

* Company Contact No.

*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
*Supervisor’s Contact No.
Department *Supervisor’s Email ID
*Remuneration
*HR Name
(Last Drawn Salary)

Confidential
 *HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit

Reason for Leaving:

*Employment Type ☐ Full - Time ☐ Part-Time

*Nature of Employment ☐ Probation ☐ Permanent ☐ Contractual ☐ Temporary
☐ Reliving Letter ☐ Experience Letter ☐ Service Letter ☐ Pay Slip
*Documents submitted
☐ Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

Employer 3
*Company Name

☐ Company/Operation Closed ☐ Functional ☐ Re-located

Company Current Status
☐ Merged with

Company also Known as

*Complete Company
Address with Landmark
(Where candidate has worked)

* Company Contact No.

*City *State
*Supervisor Name and
*Designation Designation
(As per Document)
*Supervisor’s Contact No.
Department *Supervisor’s Email ID
*Remuneration
*HR Name
(Last Drawn Salary)
*HR Contact No. and
*Employee ID
email ID
D D M M Y Y
*Date of Joining
D D M M Y Y
*Date of Exit

Reason for Leaving:

*Employment Type ☐ Full - Time ☐ Part-Time

Confidential
 ☐ Probation ☐ Permanent ☐ Contractual ☐
*Nature of Employment
Temporary
☐ Reliving Letter ☐ Experience Letter ☐ Service Letter ☐ Pay Slip
*Documents submitted
☐ Other - _______________________

Third Party
(Name and complete
address)
(If through contract)

Letter of Authorization from the Employee / Candidate

To whom so ever it may concern

I hereby authorize Mahindra Rural Housing Finance Limited (“Company”) or a third party agency
appointed by the Company to conduct background verifications to validate the information I have
provided to the Company including but not limited to my employment, my personal background,
professional standing, work history, and qualifications, etc.

I authorize, without reservations, any individual, company, or other private or public entity to furnish
to the Company or the third party agency appointed by the Company, all information about me

I release and hold harmless any individual, company, or private or public entity from all causes of action
that might arise from furnishing such information to the Company or to the third party agency appointed
by the Company that they may request pursuant to this release.

This authorization and release, in original, faxed, or photocopied form, shall be valid for this and any
future reference.

Signature
Name
(In Block Letters)
Date of Birth
Date

Confidential