13701840

Declaration

I, Shreya Das

Employee ID: 13701840

Career Level & Designation: 11

Location: Kolkata

Do hereby confirm my willingness to work in any shift including night shift. I am aware that the shift
times are subject to change and I agree to adhere to the same.

I also hereby confirm that I am aware of the Accenture Transport Policy and the provision whereby
home pick-up and drop facility is provided to women employees working during night shifts,
accompanied by either a security guard or a male employee as applicable. I am also aware of the
Accenture Transport helpline numbers which I can call in case of any emergency.

Signature:

Date: 08/08/2023
 13701840

GF_ 13701840

Form ‘F’
Nomination under Payment of Gratuity Act, 1972 [Rule 6(1)]
The Trustees
Accenture Employees Group
Gratuity cum Life Assurance scheme.

SHREYA Father
Father: DAS
Name Name/ Sur
Husband BIJAY KUMAR DAS Name
Name
Sex Employee
FEMALE Code 13701840
Religion Martial
HINDU Status
single
Date of Permanent CHANDNI BENEPUKUR NEAR -VIVEKANANDA SPORTING CLUB, P.O. + P.S.
25/04/2001 CHANDANNAGAR, DIST. HOOGHLY, PIN - 712136, WEST BENGAL
Birth Address:
Date of Joining 08/08/2023
I 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 names(s) of the nominee(s).
Sr.No Name in Full with full address of Relationship with the Age of Proportion by
Nominee/s Employee Nominee/s which Gratuity will
be shared
1 BIJAY KUMAR DAS, CHANDNI BENEPUKUR NEAR - 61 100
VIVEKANANDA SPORTING CLUB, P.O. + P.S.
FATHER
CHANDANNAGAR, DIST. HOOGHLY, PIN - 712136,
WEST BENGAL, INDIA

2. I have no family and should I acquire a family hereafter, the above nominations shall be deemed to be cancelled and fresh
nominations in favor of one or more of my family members shall be provided by me.
3. 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.
4. I hereby declare that I have no family within the meaning of clause (h) of section 2 of the said Act.
5. (a). I hereby certify that my father/mother/parents is/are not dependent on me.
(b). My husband's father/mother/parents is/are not dependent on my husband.
6. I have excluded my husband from my family by a notice dated ………to the controlling authority in terms of the proviso to clause
(h) of section 2 of the said Act.
7. Nomination made herein invalidates my previous nomination.
• Strike out the words/paragraphs not applicable..
08 day of _____
Dated this _____ 2023 at__________
08 _____ KOLKATA
 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: _________________________________

Signature of Employee
CERTIFICATE BY THE EMPLOYER
Certified that the particulars of the above nomination & declaration have been verified and recorded in the establishment.
Place:
Signature of the Trustee/Authorised person
Date: For Self and co-Trustees of Accenture
______________________ Employees Group Gratuity cum Life Assurance scheme.
ACKNOWLEDGMENT BY THE EMPLOYEE
Received the duplicate copy of Nomination in Form F filed by me and duly certified by the Employer.
Place:

Date: Signature of Employee

______________________
GF_ 13701840
 13701840

FORM-X
APPOINTMENT LETTER
(Prescribed under Rule 53 of the West Bengal Shop & Establishment Rules , 1964 )

Name of the Establishment Accenture Solutions Pvt. Ltd

Address (Joining Location to Capture) Accenture Solutions Pvt. Ltd., KDC 1, Block-B, Tower-
III, 'Infospace' Unitech Hitech Structure Ltd., IT/ITES
SEZ, Plot No. DH-1, DH-3 & DH-3/1 Block No-DH,
Action Area-1, New Town, Kolkata-700156, West
Bengal
Name of the Employer Register office Address
Accenture Solutions Pvt. Ltd.
Accenture Solutions Pvt. Ltd Plant 3, Godrej & Boyce Complex,
Pirojshanagar, LBS Marg, Vikhroli (West),
Mumbai - 400079, INDIA

Registration No S & E Registration Number

24PGS/N/N.TOWN/LWFC/R-BDO/P-II/605

Shreya Das
S. No. (1) Shri / Smt ________________________________________________ (name of the employee)
11
is appointed as ________________________________________________________(role/career level

08/08/2023
as per offer letter) in this Establishment with effect from___________________ (DOJ – dd-mm-yyyy)

S. No. (2) His / her appointment is on probationary basis for six months which may thereafter be
changed to permanent basis.
S. No. (3) His / her Scale of pay / rate of increment wages per _________Nil_______________
(insert the period) shall be____________Nil______________________

S. No (4) He / she will draw total

wages per month i.e. CTC/12 months.
Yearly composed to the following Wages will be as per Annexure I attached with the offer
namely i) Basic pay of letter
ii) Dearness allowance iii) Other allowance

Hitesh Thakkar
Senior Manager
India Lead – Employee Services,
HRSS India
Signature of the Employee Signature of the Employer
Place: Kolkata

Date: 08/08/2023

Note:- Strike out the words which are not applicable .

The Government of West Bengal has allowed the Employer / Shop - keeper to
substitute its own appointment letter which substantially contain the particulars
specified in Form - X and if prior approval is taken from State Government.
 13701840

Employee No Group No: Corporate 1

13701840
Office: Bandra

Date of Joining: 08/08/2023

NOMINATION AND DECLARATION FORM
Form - 2 FOR UNEXEMPTED AND EXEMPTED ESTABLISHMENTS
Declaration and nomination Form under the Employee's Provident Funds and Employee's Pension Scheme. (Paragraph 33 and 61(1)
of Employee's Provident Fund Scheme, 1952 and Paragraph 18 of Employee's Pension Scheme, 1995)
Name (in Block Letters) SHREYA DAS

Father's / Husband's Name Father: BIJAY KUMAR DAS

Date of Birth
25/04/2001

Sex
FEMALE

Marital Status single

PF Account NO MH/BAN/45665/

Present Address HALL 13, NIT DURGAPUR, MAHATMA GANDHI ROAD, A ZONE, DURGAPUR -
713209

Permanent Address CHANDNI BENEPUKUR NEAR -VIVEKANANDA SPORTING CLUB, P.O. + P.S.
CHANDANNAGAR, DIST. HOOGHLY, PIN - 712136, WEST BENGAL

PART -A (EPF)

I hereby nominate the person (s) / Cancel the nomination made by me previously and nominate the person(s), mentioned below
to receive the amount standing to my credit in the Employees' Provident Fund in the event of my death

Name & Address of the Nominee's Date of Total amount or share of If the Nominee is a
nominee /nominees relationship with Birth Accumulations in Provident minor, name and
the member Fund to be paid to each relationship & address of
Nominee (percentage) the guardian who may
receive the amount during
the minority Of nominee
Bijay Kumar das , Chandni 01/01/1962 100
Benepukur, chandannagar , Father
Hoogly, West Bengal, Pin - 712136
1. * Certified that I have no family as defined in para 2(g) of the Employees Provident Fund
Scheme 1952 and should I acquire a family hereafter the above nomination should be deemed as
cancelled.
2. * Certified that my father /mother is / are dependent upon me. *Strike out whichever is not
applicable.

X Signature of the Employee

part -B (EPS) (Para-18)

I hereby furnish below particulars of the members of my family who would be eligible to receive Widow / Children Pension in the
event of my death.

SR.NO Name and Address of the Family Members Date Of Birth Relationship with Member
1

** Certified that I have no family, as defined para 2 (vii) of the Employees' Pension Scheme,1995 and should I acquire a family
hereafter I shall furnish particulars there on in the above form

I hereby nominate the following person for receiving the monthly widow pension [ admissible under para 16 (2) (i) & (ii) in the
event of my death without leaving any eligible family member / s for receiving pension.

SR.NO Name and Address Of the Nominee Date of Birth Relationship with Member
1 Bijay Kumar das, Chandni benepukur, 01/01/1962
Father
chandannagar, Hooghly, Pin - 712136
 08/08/2023
DATE
Strike out whichever is not applicable
X Signature of the Employee
CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed before me by Shri/Smt/Kum

employed in-my/our Establishment after he/she has read the entries/entries has been read over to him/her by me and
got confirmed by him/her
For

Authorized Signatory

Accenture Solutions Pvt. Ltd,

Plant 3, Godrej & Boyce Complex,
LBS Marg, Vikhroli (W), Mumbai -400 079
Place: Mumbai
Date: 08/08/2023

PF_Emp.ld
13701840
 13701840
....,,

ON_ 13701840

Nomination form for other Benefits

Accenture Solutions Pvt. Ltd,
Plant 3, Godrej & Boyce Complex,
Pirojshanagar, Vikhroli (West),
Mumbai - 400 079.
Name Father Name/ Husband Name

I
Shreya Das Father: BIJAY KUMAR DAS
Employee I Date of birth Date of Joining
25/04/2001 08/08/2023
Code
13701840
Gender Female Marital Status single

I hereby nominate the person(s) mentioned below to receive all my dues after my death in proportion
indicated against the name(s) of the nominee(s).

Group Personal accident

Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

F1,1II & Fina! payments {ie Ynclaimed reimbYrsement, Ynpaid salary, leave etc)
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

Employees Deposit Link Insurance

Sr.No .Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

American Express Corporate Credit Card

Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100
 ....,,

Group Mediclaim
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

Future Service Liability

Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

Overseas Travel Insurance

Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

Group Term Life Insurance

Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation
Employee Nominee/s to be paid to nominee(%)
1 Bijay Kumar das Father 61 100

Declaration by Witnesses:
Name Name
Employee code Employee code
Signature Signature
Place Place
Dated Dated

Employee Code 13701840 I

Location Kolkata
Employee Signature Date 08/08/2023

Certificate by the Employer:

Certified that the above nomination as declared by the employee is taken on record.

Place Kolkata
Date Signature of Authorized Signatory
08/08/2023
For Accenture Solutions Pvt. Ltd
ON_ 13701840