oe or veoaian ages esd rele ee i laa Please fillin the complete form, sign It and hand over to your Induction Coordinator (ua To be filled by Candidate Candidate’s Personal Details: PURNAH CHANDR act name: _ S4HO 7 Gondor: [E}Male [I] Female Bate of bith (oo/mna/vyy 5" /D5 LAP Contact No: (wm) 1348 SEARS tay Blood Group: B+ Candidate’s Medical History: Candidate's Medical Details Do you suffer from any defect of vision? Yes, has it been corrected by suitable spectacles? Mr./Mrs./Ms./Miss/Or. First Name: E N SIS AISIRRISSIAL TS Can you readily distinguish between the pigmentary colors, Red and Green? Do you suffer from a degree of deafness which would prevent your hearing ‘of normal conversation and ordinary sound signals? Do you have any physical deformity / handicap or use any mechanical / physical assistance for mobility? Do you have any congenital disorder / abnormality? Have you ever been diagnosed to have any Psychiatric ailment including Depression, Anxiety Neurosis, Phobic Disorders, Schizophrenia, Manic Depressive Psychosis or any other Psychiatric illness? Have you had any form of critical illness or operation in the last two years? Have you ever been disqualified on medical grounds from any previous ‘employment opportunity? Have you ever been diagnosed with or do you suffer from any other Medical condition that may require you to take Medical Leave over the next 12 months? Have you ever been diagnosed to have Cancer, Tumor, Cyst or any similar type of growth? Have you ever been diagnosed with an alcohol or drug abuse problem? If ‘yes, are you on treatment for the same? Have you ever suffered or suffering from any of the following? (Please (v) tick wherever applicable and provide necessary details) Valve Disorders igh Blood Pressure stroke Heart Attack Diabetes “Tuberculosis Angina Pectors ‘asthma Sipped disc Atri Obesity Epilepsy Night Blindness Hepatitis 8 Hepatitis ¢ fearcna Chanda Saher TCS Confidential Candidate's Signature Page [1Candidate's Declaration: | declare that to the best of my knowledge, the answers tothe questions inthis form are correct and that | am not suffering from any disease/illness, the presence of which | have not revealed. | fully understand that any misrepresentation of this declaration could lead to the termination of my offer/appointment. | have no objection to Tata Consultancy Services Ltd, seeking further information either directly from me or from my Consulting doctor or other appropriate doctor. In case of any discrepancy arising out of my declaration, | will be undergoing the medical check-up by the Company’s suggested medical cliie/dactor and thie findings wil be fully binding on me and any action thereon towards my employment will be accepted by me. . sienes_Furcna ohavolra Saher ate: (nnyaanayvyy!5 2.1 202.2 ‘The Candidate needs to ensure that a legally qualified and registered medical practitioner with minimum qualification as M.8.8.S. completes this form. Additional sheets may be attached if more space is required. Note: The candidate is responsible for any costs associated with the preparation of this report To be filled by Medical Practitioner Doctor's Details: Full name (as listed on applicable state registry) DR €VStton/Te-. KLM An Registration ID: Lee foq Contact No: (Day time) 7 REA ET On Postal Adds Asha Doctor's General Examination Remarks: weigne 56> trey eee ° £0EL lems) sho ressure:_/2272D mm he Pulse:__ 7-6 tein) BMI (Calculated Value): rt * Genera Examination Findings: Pet Je [yw [02d AD: ‘Systemic Examination - CVS/RS/Abd/CNS/Others: LVLE MN Doctor's Declaration: ear ree ena ear art een tO ree Oo here eee Lahn _ Hefei s mesically jenfctor employment with TCS. Sadonghena Sehr — tence vaccinoped Sy Covelt9 Ot 22. Signed & Sealed: pate: (oopmmprn S7, ‘TCS Confidential Page | 2