INSTRUCTIONS FOR FILLING THE FORM

1. Please follow the guideline comments for entering information, wherever provided.
2. Please enter ALL details in BLOCK letters, except for email address.
3. Please ensure all information being captured is correct.
4. Please use TAB to move from one field to the other, to go back use SHIFT+TAB
5. Certain details such as Name, Date of Birth, Marital Status, Nominee details etc. once
captured, will automatically reflect in the other sheets where required
6. Please fill family details correctly. If family details are not entered correctly,
the nominee details wherever applicable, will not be captured properly.
7. If information provided / entered is incorrect, it will reflect in
details must be rectified before printing and signing the form.

ORANGE color. Incorrect

8. After filling the form, please sign wherever the numbers have been provided. For e.g

DOCUMENTS CHECK - LIST

Emp Name
Name of
HRRM
Sr No.

Che

Documents

Acceptance copy of Appointment letter ( HR-RM Sign & Employee Sign - 2 each)

Salary Breakup sheet ( HR-RM Sign & Employee Sign)

Employee Data Form (1 Sign)

Joining confirmation / Joining Report (1 Sign)

Declaration & Authorization (1 Sign)

PF Nomination Form (2 Signs)

PF Form 11 (1 Sign)

Gratuity Nomination Form (2 Signs)

Mediclaim Enrolment form (1 Sign)

10

Life Cover Beneficiary Form (1 Sign)

11

ID- Card Application Form (1 Photo)

12

Doctors Certificate (As per Format, in original) / (MBBS & Registration No )

13

Acknowledgment of Share dealing Code (1 Sign)

14

Acknowledgment of Corporate code of conduct (1 Sign)

15

Account opening request Letter (Branch code)(1 Sign)

16

IT Security Agreement (1 Sign & Witness Sign)

17

Relieving / Experience / Acceptance of Resignation Letter (Wherever applicable)

18

Qualification marksheets & certificates (Graduation / Post Graduation)(OSV)

19

DOB Proof (Birth Certificate / School Leaving Certificate / Pan card)(OSV)

20

PAN Card Copy / Copy of Form (49A / 60)(OSV)

21

3 Passport Size Photographs

22

Address Proof (OSV)

23

Proof of Bank account details for beneficiary form

02-NOV-2016

17

Employee Signature

Date

21

hecklist
Yes/No

Employee Data Form

Name
(In Block Letters)

SURNAME

FIRST NAME

MIDDLE NAM

Preferred Name
(In Block Letters)
(This name will be used as short name in communications)

Preferred
official email id :
Father's Name
(In Block Letters)

SURNAME

FIRST NAME

Date of Birth

Gender

Nationality

Category

PAN/GIR No.

Passport No.

UAN

Aadhar No.

Marital Status

Blood Group

Anniversary Date

Religion
Domicile

Residential Address (Welcome Kit from KMBL will be dispatched at this address)

Telephone Number
Personal Email ID
Cell Phone Number
Permanent Address

Pincode
Alternate Cell No.

Telephone Number

Pincode
1

MIDDLE NAM

Family Details
Sr No

Name of Family Member

Relationship

Date Of Birth

Occupa

1
2
3
4
5
6
7
8

Academic Details (Begin with last qualification)

Month &
Year of
Passing

Degree /
Diploma

Subject of
Specialisation

School / College /
Institute and
Location

University /
Board

Special Training, if any (Project Work, Course Assignments, On Job Training, Seminars Attend

Intrests and co-curricular pursuits

(Please provide details of particulars / membership & positions of leadership / offices held if any)

Experience Records (Begin with last employment)

From

To

Organisation Name

Position(s) held

Reason for le

Employment Details of Last Employment

Last Employment (Emp 1)
Employer Name and full
address

Prior to Last Employment (Em

ADASDASDSAD

Office Landline Numbers

Dates Employed

to

to

Job Title / Designation

Gross Salary
Supervisor Name
Supervisor Mobile No.
Reason for Leaving
Employee Code
HR Contact Name
HR Contact Email

Reference Details for Professional Reference Checks

Reference 1
Reference Name
Reference Designation
Reference Organisation
Name
Landline Number
Mobile Number
Period for which he/she
knows the candidate
Association with the
candidate

Reference 2

Do you have any of your relatives working with Kotak Group companies or its subsidiaries ?
If yes, please provide the below details
Name of the person

Relationship with
the person

Name of the
Company

Employee code
(if available)

Position

Do you have any relatives working with any government organization (such as Income Tax or Provident Fund
or Municipal Corporation or Police etc) ?
Name of the person

Position

Organisation

Languages known (Indicate proficiency as being "fluent" and "fair")

Languages

Speak

Read

Writ

Contact Person (In case of Emergency)

Sr No

Name

Address

Tel . Number

Cell Nu

1
2
3

I,
hereby declare that the information mentioned above
is true to the best of my knowledge .I shall be solely responsible for any discrepancy / misleading
statements and also it is upon me to communicate any additions / changes to the above information
to the HR in writing .

Signature :
Date :

02-NOV-2016

Place

AME

AME

pation

% of
Marks

nded etc)

leaving

Emp 2)

on

rite

umber

ve

Joining Report
Name
2016

Date of Joining
(DD-MM-YYYY)
Department
Grade
Designation
Location

Declaration
I confirm that Mr./Ms.
mentioned date.

has joined the bank on the abov

Signature of the Dept. Head

Name of the Department Head

Signature of the employee

Name of the employee

For HR's Use Only

Encl.:

Salary Fitment Sheet

Signature of the Authorized HR

The above date of joining as mentioned in this report supercedes any earlier joining date mentioned in the
Appointment letter or any other communication made to me in this regard.
Revised DOJ
Signature of the employee
5

ove

R Person

DECLARATION AND AUTHORIZATION

I hereby authorize Kotak Mahindra Group of companies (or a third party agent by the Company) to
contact any former employers as indicated above and carry out all Background checks not restricted to
education and employment deemed appropriate through this selection procedure. I authorize former
employers, agencies, educational institution etc. to release any information pertaining to my
employment / education and I release them from any liablity in doing so.

I confirm that the above information is correct to the best of knowledge and I understand that any
misrepresentation of information on this application form may, in the event of my obtaining
employment, result in action based on the company policy.

Signature :

Name :

Date :

02-NOV-2016

FORM 2 (REVISED)

For Office use on

NOMINATION AND DECLARATION FORM FOR

Inward No:
Group No.:
Office At.:

UNEXEMPTED / EXEMPTED ESTABLISHMENT

Declaration and Nomination Form under the Employee's
Provident Fund & Employee's Pension scheme
(Paragraph 33 & 61(1) of the Employees' Provident Fund Scheme,
1952 & paragraph 18 of the Employees' Pension Scheme, 1995)
1 . Name (In Block Letters)
2 . Father's/ Husband's Name
3 . Date of Birth

--

4 . Sex

5 . Marital Status

6 . Account No
(married / unmarried / widow / widower)

7 . Address
Permanent
Temporary

PART -A (EPF)

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

Name of the Nominees

Address

Nominee's
relationship with
the member

1.

Date of Birth

Total amount or
share of
accumula-tions in
Provident Fund to
be paid to each
nominee
5

If the nominee
name & relat
address of the
who may rec
amount dur
minority of n
6

2.

* Certified that I have no family as denied in para2(g) of the Employee's Provident fund Scheme ,1952
and should I acquire a family hereafter the above nomination should be deemed as cancalled.
* Certified that my father / mother is / are dependent upon me.

Strike out which ever is not applicable

4
7

Signature or thumb impression of the subscribe

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.
1

Name & Address of the family member

Name

Address

Date of Birth

Relationship with

1
2
3
4
* Certified that I have no family, as defined in para 2 (vii) of the Employees' Pension Scheme, 1995 & should
I acquire a family hereafter I shall furnish particulars thereon in the above form.
I hereby nominate the following person for receiving the monthly widow pension (admissible under para
16(2)(a)(i) & (ii) in the event of my death without leaving any eligible family member for receiving pension.

Date :

Name & Address of the nominee

Date of Birth

Relationship with the

3

02-NOV-2016

* Strike out whichever is not applicable

Signature of thumb impression of the subscribe

CERTIFICATE BY EMPLOYER
Certified that the above declaration & nomination has been signed/ thumb impressed before me by Shri/ Smt.
Kum
employed in my establishment after he / she has read the entries / entries have been read over to him / her
by me & got confirmed by him / her
Place

Signature of the employer or other Auth

Officer of the establishment

Designation
Name & Address of the Factory/ Establishment or Rubber Stam
8

only

death

ee is a minor,
ationship &
he guardian
receive the
during the
of nominee

ber
(P.T.O)

ith member

he member

ber

uthorised
t

amp thereof .

FORM No. 11 (Revised)

(Unexempted Establishment Only)
THE EMPLOYEES PROVIDENT FUND SCHEME, 1952(Paragraph 34)
And
THE EMPLOYEES PENSION SCHEME, 1995(Paragraph 24)

Declaration by a person taking up employment in the establishment

in which the Employees' Provident Funds & Family Pension Fund Scheme Enfoce
I,
S/O, W/O, D/O
Do hereby solemnly declare that :a. I was employed in M/s.
0
ADASDASDSAD
with PF A/c No.
and left service on
prior to that I was employed in
with PF A/c No.
From
To
b. I am a member of the pension fund from
To
and copy of the scheme certificate is enclosed.
c. I have/ have not withdrawn the amount of my Provident Fund / Pension Fund.
d. I have/ have not drawn any benefits under the employees Pension Scheme,1995
in respect of my past service in any establishment.
e. I have/ have never been a member of any Provident Fund and/ or Pension Fund.

DATE:

02-NOV-2016

* Signature or left hand thumb impression

of the employee.

Encl: Copy of the Scheme Certificate.

(To be filled by the employer)
1 Shri / Smt. / Miss

is appointed as
Name of Employee

in M/s.

Designation
with effect from

(Name of Factory / Establishment)

bearing PF A/c.No.

(Date of appointment)

2 Copy of Scheme Certificate is enclosed.

3 Declaration & Nomination in from 2 is enclosed.
DATED :

02-NOV-2016
Signature of the employer or manager
or other authorized officer.
* Left hand impression in the case of illiterate male member
and right hand impression by illiterate female member.

oce

Designation

pointment)

male member
male member.

FORM 'F'

THE PAYMENT OF GRATUITY ACT

[See Sub-rule (1) of Rule 6]

NOMINATION
To,

(Give here name or description of the Establishment with full address)

1 . I, Shri / Shrimati / Kumari

Whose particulars are given in the statement below ,hereby nominate the person(s) mentioned elow to receive the gra

payable after my death as also the gratuity standing to my credit in the event of my death before the amount has beco

payable, or having become payable has not been paid &direct that the said amount of gratuity shall be paid in proporti
indicate against the name (s) of the nominees (s)

2 . I hereby certify that the person (s) nominated is a/are members(s)of my family within the meaning of clause (h) of sect
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 control

authority in terms of the proviso the 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 Nominees(s)

Relationship with
the employee

Age of
nominee

(1)

(2)

(3)

(1)

(2)

(3)

(4)

so on,

Proporti
which the
will be s

(4)

STATEMENT
1 . Name of the emploee in full
2 . Sex

3 . Religion

4 . Whether unmarried/married/widow/widower
5 . Department / Branch / Section where employed.
6 . Post held with Ticket No . or Serial No., if any
Vilage

7 . Date of appointment

Thana

Post Office

--

Subdivision

District

State

Place
Date

02-NOV-2016

Signature / Thumb-Impression of the Em

DECLARATION BY WITNESSES
Nomination signed / thumb impressed before me .
Name in full and address of witness

Signature of witness

1.
2.

1.
2.

Place :

Date :

02-NOV-2016

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 stamp thereof

Signature of the employer/office au

Date:

02-NOV-2016

Designation:

ACKNOWLEDGEMENT BY THE EMPLOYEE

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

Date :

NOTE : Strike out the words and paragraphs not applicable.

10

Signature of the Emp

CT 1972

ratuity

come

rtion

ection 2

olling

tion by
e gratuity
shared

4)

mployee

sses

authorised .

mployee

ENROLMENT FORM FOR MEDICLAIM INSURANCE POLICY

Employee Name :

Employee Number :

Grade :

Designation :

Department :

Location :

PARTICULARS OF THE PERSONS PROPOSED FOR COVERAGE UNDER MEDICLAIM SCHEM

Sr No .

DATE OF BIRTH
(DD-MM-YYYY)

NAME

RELATIONS

PLACE :

9
DATE :

EMPLOYEE'S SIGNAT

02-NOV-2016

Note :
n

This form is essential for enrolment of coverage under group mediclaim , thus all the above details
need to be furnished correctly and completely at the earliest. Without the submission of this form
neither the employee nor nominated dependents will be covered.
The employee is entitled to nominate parents or in-laws, spouse and 2 children. Siblings and grand
parents are not covered.

11

EME

NSHIP

ATURE

Beneficiary Nomination Form

EMPLOYEE NUMBER :

BENEFICIARY DETAILS
Name of
Beneficiary *

*
**
***

Proof of
Identity **

Relationship
to the policy
holder

% Share of
Benefit

Bank Deta

If minor, the details of the guardian with proof of identity required

Original certified copy required .
Bank Details required are :
n Bank Name
n Bank Branch Name/Code
n Account No
n Account Type

EMPLOYEE SIGNATURE :
(1) NAME

SIGNATURE

10
For HR use only

Date of receipt of Form:

Received By:
Signature:
PLAN NAME :
POLICY NUMBER :
Employee Number :

Kotak Term Grouplan

12

DATE

02-NO

etails ***

-NOV-2016

APPLICATION FOR IDENTITY CARD

PLEASE ENTER THE DETAILS IN CAPITALS

NAME
EMP CODE
BLOOD GROUP

13

Format for Medical Certificate

(on Letter head with Registration No .)

DECLARATION OF MEDICAL FITNESS

I, the undersigned Mr. /Ms

LE

checked Mr./ Ms

and certified that he / sh

medically fit and that he / she does not suffer from any serious illness of infection or any other terminal or

Dated :

SA
M

Signed :

communicable illness .

Note : Doctor has to be atleast MBBS

14

have

she is

ACKNOWLEDGEMENT FORM FOR EMPLOYEE SHARE DEALING CO

Declaration
I acknowledge the receipt of Kotak Mahindra Bank Limited Employee Share Dealing Code and procedures
made thereunder ("the code.") .I have read the code & hereby confirm my understanding & acceptance
of the code .

I am aware that the Bank reserves to itself the right to check with brokerage firms / relevent agencies and
authorities and obtain details of any securities transaction done by me or my affected relative/s. I am also
aware that in such circumstance, if the Bank after checking with brokerage firms / relevent agencies and
authorities finds that securities transaction has been done by me in violation of the Code, the Bank has the
right to take any action against me.

I hereby authorise the Bank or any of its Directors or Officers or seek such information as they deem
necessary from any brokerage firm, stock exchange, clearing house, depository, bank or any other
authority or agency that may be in possession of information relating to any trading activity carried on by
me or by any of my affected relatives. I agree and confirm that any information provided by an organisation
pursuant to the authority hereby granted would not be a breach of confidentiality obligations contained in
any agreement / arrangement between me and such organisation.

11

Signature :

Name of Director/ Employee :

Employee Code :

Employee's Designation :

Branch / Department :

Date :

02-NOV-2016

15

CODE

Corporate Policy Manual on Conflict of Interest,

Confidential and Proprietary Information
MEMORANDUM
This acknowledgement must be Signed and returned to the Human Resources Function, Kotak Mahindra
Bank Ltd., within 10 days.

I have received the Kotak Mahindra Bank policies & procedures regarding conflict of interest, confidential
and proprietary information. I have read and agreed to comply with these policies & procedures. I
understand and agree that failure to observe these policies and procedures and such other policies and
procedures as may be in the force from time to time & may subject me to disciplinary action .

12
Signature :

Date :

Name :
(in block capitals)

Department :

Employee No :

For Human Resources Use Only :

Data Entered :
(Signature ,Name,Designation & Date)

Sent to compliance for review :

16

02-NOV-2016

Date :

02-NOV-2016

To,
The Human Resoures,
Kotak Mahindra Bank Limited
Mumbai
Subject :

Request for opening staff Bank A/c with Kotak Mahindra Bank Limited / updating Exsiting

Dear Sir ,
I,
/ Kotak Group Company on

have joined / am joining Kotak Mahindra Bank Limited

--

I request you to open my Bank Staff A/c and Reimbursement A/c with Kotak Mahindra Bank / update my
existing Kotak Mahindra Bank A/c for salary processing and open Reimbursement A/c.
For New Staff A/c and Reimbursement A/c Opening
A/c Type (Please tick the appropriate A/c):
Staff Edge A/c (Scheme Code : LSTEDG)
Staff Ace A/c (Scheme Code : LSTACE)
Name of the Branch

Branch Cod
OR

Branch Code

Name of the Branch

For Updating Existing Bank A/c and Opening Reimbursement A/c

I am having a Savings A/c with Kotak Mahindra Bank with following details:
CRN:

A/c No:

I authorize Kotak Mahindra Bank to change the Scheme Code of my existing Savings A/c and open a
new Reimbursement A/c on the same CRN.
Scheme Code (Please tick the appropriate A/c)
LSTEDG (Staff Edge A/c)
LSTACE (Staff Ace A/c)
I have read / obtained and understood the GSFC of the A/c I have opted for. I will ensure to submit the
required documents in the branch to activate the same.
Thanking you.
Yours faithfully

13

17

ng A/c

ode

AGREEMENT TO COMPLY WITH INFORMATION SECURITY GUIDELINES

Each one of us is responsible for ensuring compliance with Kotaks Information Security Guidelines.
The undersigned confirms that he/she
p

has read the relevant Information Security Acceptable Usage Guidelines and understands the
procedures described therein.

agrees to abide by the guidelines described therein as a condition of continued employment /

contract.

will attend the Information Security Induction training which is part of corporate induction
programme for all new joiners.

understands that violators of these guidelines are subject to disciplinary measures including
termination of employement / contract.

understands that access to the information systems of the company is a privilege which may
be changed or revoked at the sole discretion of the company.

will promptly report all violations of the information security policies and security incidents
of to aristi@kotak.com

14

User's signature

02-NOV-2016
Date

User's name in block capital letter

Location

Department

02-NOV-2016
Date

Witness name and signature

18

ES

KOTAK MAHINDRA GROUP OF COMPANIES

INCOME TAX DECLARATION FORM
(To be used to declare investment for income Tax that will be made during the period)
Company Name

Ticket No (Emp no)

Reporting Location
No. of Documents
attached
PAN(Compulsary -pls
attached a copy of
your
PANcard/Form 49A)

Employee Name MR. / MS.

Date Of Joining

--

Address

ITEMS

PARTICULARS

MAXIMUM LIMIT

DECLAR

DEDUCTION U/S 10

I'm staying in a rented house & I agree to submit rent receipt

when required. The rent paid is (Rs.

HOUSE RENT

months) & the

METRO

house is located in a METRO / NON METRO (Tick whichever is

applicable)
Max Limit
Sec 80D - Medical Insurance Premium (if the policy covers a
senior citizen then exemption is Rs.20000/-)

DEDUCTION
Sec 80E - Repayment of loan for higher education (only
UNDER
interest for loan taken prior to employement)
CHAPTER - VI A
Sec 80U - Handicapped

Declar

15,000.00
40,000.00
50,000.00

Any other Deduction (Please specify)

Max Limit
Sec 80CCC - Contribution to Pension Fund (Jeevan Suraksha)

100,000.00

Deferred Annuity

100,000.00

Public Provident Fund in own name or spouse & child

only

DEDUCTION
U/S 80C

100,000.00

Life Insurance Premium on life of self or spouse & child

only

70,000.00

ULIP of UTI/LIC in own name or spouse & child only

100,000.00

Principle Loan (Housing Loan) Repayment for fully

constructed property

100,000.00

Contribution to Pension Fund or UTI or Notified Mutual Fund

100,000.00

Notified scheme of ELSS of Mutual Fund

100,000.00

Investment in Notified Infrastructure Bonds

100,000.00

Children Tuition Fee: Restricted to a max 2 children

100,000.00

Deposit in home loan account scheme of NHB/HDFC

100,000.00

Investment in NSC- Only Fresh Invsts made in current

year

100,000.00

Interest Accrued on NSC VIII Isuue (Calculation table is

provided separately)

100,000.00

Investment in 5 year Fixed Deposit Scheme

100,000.00

NOTES:
1.

The maximum amount of investmentS qualifying for deduction u/s 80C & 80CCC together is Rs.1,00,000/-.

2.

Premiums on LIC paid in excess of 20% of the actual sum assured will not qualify for deduction & hence excess
premia paid should be excluded from the above details.

3.

The LIC premium paid should not include the amount of which deduction is claimed u/s 80ccc & also the late
fees is not included.

19

Declar

Decla
If yes,Form 16 from previous employer or Form 12B with tax compution to be attached
SALARY paid by the Previous Employer after Sec 10 Exemption

Previous
Employement
salary (salary
PROFESSIONAL TAX deducted by the Previous Employer
earned from till
PROVIDENT FUND deducted by the Previous Employer
date of joining)
INCOME TAX deducted by the Previous Employer

Non
Employement
Declaration for
employees
joined post

I hereby declare that this being my first job, I do no have any salary income prior to
joining this company.

Note : The above mentioned amounts will be considered based on actual proof given
Max Limit
DEDUCTION
U/S 24

Interest on Housing Loan on fully constructed

accomodation only

Declar

150,000.00

Interest if the loan is taken before 01/04/99 on fully

constructed accomodation only and for repairs

30,000.00

DECLARATIONS:
1.

I hereby declare that the information given above is correct & true in all respects. I am also aware that the
company will be considering the above details in utmost good faith based on the details provided by me
and that I am & personally lible for any

2.

I am also aware that any person making a false statement /declaration in the above form shall be liable to
be fined and prosecution u/s 277 of the income Tax Act,1961

3.

The proof of payment / Supportings for claim, will be provided post December 2009 latest by February 10th,2010.

4.

The following members of my family are financially dependent on me.

RELATIONSHIP

NAME OF THE DEPENDANT

AGE

Statement showing details of Interest Accrued on NSC -VIII Issue

The year for
which interest
accrues

No. of years completed

(Rs.)

Certificate Amount

Accrued int.rate

First Year

8.16%

Second Year

8.83%

Third Year

9.55%

Fourth Year

10.33%

Fifth Year

11.17%

Sixth Year

12.08%

Date :

Intere

02-NOV-2016

Place :

20

15

SIGNATURE OF THE EMPLO

RED AMOUNT

ared Amount

ared Amount

clared Amount

ared Amount

rest Accrued

LOYEE

Form No. 60
[See third proviso to rule 114B]

Form of declaration to be filed by a person who does not have either a permanent
account number or General Index Register Number and who makes payment in
cash in respect of transaction specified in clauses (a) to (h) of rule 11B

1. Full name and address of the declarant

2. Particulars of transaction
3. Amount of the transaction
4. Are you assessed to tax?
5. If yes,
(i) Details of Ward/Circle/Range where the last return of income was filed?
(ii) Reasons for not having permanent account number/General Index Register Number?
6. Details of the document being produced in support of address in column (1)

Verification
I,
true to the best of my knowledge and belief.
Verify today, the
Date:

2ND

day of

do hereby declare that what is stated above is

JAN 2016

02-NOV-2016

Place:

16

Signature of the dec

Instructions: Documents which can be produced in support of the address are :(a) Ration Card
(b) Passport
(c) Driving licence
(d) Identity Card issued by an institution
(e) Copy of the electricity bill or telephone bill whoing residential address
(f) Any document or communication issued by an authority of Central Government, State Government
or local bodies showing residential address.
(g) Any other documentary evidence in support of his address given in the declaration.
14

is

eclarant