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    Indian Corporation Limited: ? Oass Ast

    Uploaded by

    rock
    This document contains a form for verification of character and antecedents in respect of contractors, mobilizers, and tanker drivers for Indian Oil Corporation Limited's Chittoor Smart Terminal. The form collects personal information such as name, age, address, qualifications, identification marks, previous employment details, driving license information if applicable, and contact details of two references. The contractor engaging the worker must also provide certification of knowing the worker and taking responsibility for their conduct on site. No financial liability is imposed on Indian Oil Corporation for the worker's engagement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Indian Corporation Limited: ? Oass Ast

    Uploaded by

    rock
    40 views2 pages
    This document contains a form for verification of character and antecedents in respect of contractors, mobilizers, and tanker drivers for Indian Oil Corporation Limited's Chittoor Smart Terminal. The form collects personal information such as name, age, address, qualifications, identification marks, previous employment details, driving license information if applicable, and contact details of two references. The contractor engaging the worker must also provide certification of knowing the worker and taking responsibility for their conduct on site. No financial liability is imposed on Indian Oil Corporation for the worker's engagement.

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    j&H

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    This document contains a form for verification of character and antecedents in respect of contractors, mobilizers, and tanker drivers for Indian Oil Corporation Limited's Chittoor Smart Terminal. The form collects personal information such as name, age, address, qualifications, identification marks, previous employment details, driving license information if applicable, and contact details of two references. The contractor engaging the worker must also provide certification of knowing the worker and taking responsibility for their conduct on site. No financial liability is imposed on Indian Oil Corporation for the worker's engagement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views2 pages

    Indian Corporation Limited: ? Oass Ast

    Uploaded by

    rock
    This document contains a form for verification of character and antecedents in respect of contractors, mobilizers, and tanker drivers for Indian Oil Corporation Limited's Chittoor Smart Terminal. The form collects personal information such as name, age, address, qualifications, identification marks, previous employment details, driving license information if applicable, and contact details of two references. The contractor engaging the worker must also provide certification of knowing the worker and taking responsibility for their conduct on site. No financial liability is imposed on Indian Oil Corporation for the worker's engagement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

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    gBr{3,f'qd
    INDIAN OIL CORPORATION LIMITED
    CHITTOOR SMART TERMINAL
    €.
    lndainoil
    PARTICUIAR FOR' VEBIFICATION OF CIIABAC'IER AND
    e
    ANTECEDDNT IN BESPDCT OT CONTBACTOBS /
    IIIOBITERSI / TT DBIVERS

    1 Name in Full ()
    2 Age lsn uas
    3 Male / Female

    4 Blood Group
    r:?+-
    5 ld Mark
    A na0"ag"..,.r0" La--f .D,r &
    5 (a) Qualification with name & address the School
    . (A) Present Address (pe|iod * (B) Past Address (period)
    6 of stay)
    . lf the period of stay in less than 5 years, the
    Previous address where he stayed during last
    5 years be also taken

    Mllage
    Post
    Police Station 1..r

    t
    Dist
    State
    A-,?
    Mobile No.
    L^ke 2 t612
    7 Permanent Address
    Village
    Post
    Police Station
    Lro...la. ".-.a-
    Dist
    @'r(
    State
    8 Place of Birth
    trq.t
    lf employed earlier as contra ct workman, then give
    I details including name of the establishment /
    duration etc.,
    10 Particulars of place(s ) where the worker resided
    during last five years
    11 Whether ever arested / prosecuted / kept under
    detention / fined byu a court of law / convicted by
    any court, if so give details
    r.t-

    12 Give two reference wilh name address of the


    persons in your locality with 1) K(rcg - ?>oass;ast
    contact No / Mobile No. 2) i-rq$4"H- n\QSz-t:tt

    13 PF No of Last employment
    14 Details of Bank &Ar/c No.
    a >',>3r-? r.r{?
    '15 Previous pass reference, if any r\CA\
    to For TT Crew DAvCvr
    II a) Driving Licence
    b) lssuing Authority
    No.
    D{"Frt P
    Cr?- 804.
    ooqR (q>"-€oq

    II c) Operating Vehicle
    d) Name of the Helper
    No
    ffi("f 1F o)a51
    Fn ntti fl rt
    Declaration
    3
    ', Itrq

    I certify that the information given by me as above


    is true and. I am responsible for my conduct inside
    the worUsite premises & for the inforrnation pro-
    vided €
    aJ.
    Signature worker with date
    Details of the contractor engaging the above
    18
    person as contractors worker ViEHlJu P/DH/4 u14

    a Name of contractor: S&r pi oft)A A-oLV-46"A/LA'--


    Work Order No.

    b Mobile No
    17Sq{sfo76
    61re'e-L$ lal tM sc{'"{T atlo( f
    c Address of the Contractor : L-\\\ l3
    d Father's Name €-( (nuuP
    f It/lobile No
    (s:: L\7>1 47
    I / We certify that I / we know the above Labour personally and to best of my / our knowldege he I she
    bears good conduct. I / We are responsible for his / her conduct inside the work / slte premises. No liability
    either financial or otherwise on IOCL on all the above engagement. Any wrong information made, passes will
    be treated invalid or cancelled.

    rr lrl,lit:'; r'ri;i,,i, iii1,'itlr iilLrir'd'-11!.0Ii'ier[i'

    .;t..
    hfr'pi
    {,1...n!AGt:p
    (Seal)

    Signature of the contractor with seal & Date

    Contract Reference

    p
    For warding otfi.",., lfOC ffi

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