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Squad lndia Secure Services Pvt Ltd
3rd Floor, l5th Cross, E Block, Sahakara Nagar, Hebbal, Bangalore,560092

MOVEMENT ORDER (MO)

Application No.
Application Date.

Ref : SCISS/ADM N/BRD/Februa ry .20231

Date: 1410212023

'fo,

Respected Sir/Madam,
'fhis ts to inform you that Security Guard, RAMANNA G D D/O DASAPPA has been chosen for
deployment at your unit w.e.f. 14-02-2023 under your control againsUas Secunty Guard MNP S/O
DEF as a reliever/for new deployment.

You are requested to consider his candidature for performing the duties as per your SOP at your
iocation.

Enclosures (Please select from the document list):

o Biodata
o Address Proof-Aadhaar Card
o lD Proof-Pan Card
o EducationalCertificates
o PCC
o Medical Certificate
o Temporary l-card
o Training Certificate
o Bank Passbook/Cancel Cheque
o Driving License

As thls is a sysfem generated document so no need of any signature & stamp

3rtJ F!or:r. 151ir Cress. E fllock,$ahakara Fhc*r*:0ti0-?63?0114 nnrail: hr@squadrndia.c$rn

Naga{'. l'{sbhfi,, $afiS&le:rs, $6$$S? Websile: wlryr.squadifi{ii*-corn

i
irr.; : i;',:l I ilx :l:l'i*1 { t-a;i'}1;ii\': Zi:}
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 n-.

-r& Squad lndia Secure Seruices Pvt Ltd

3rd Floor, 1Sth Gross, E Block, Sahakara Nagar, Hebbal, Bangalore, 560092

Ref No.
Dala.14lA2l2023
BIODATA
APPLICATION No

APPLICATION DATE 14t02t2023

PF NUMBER

UAN NUMBER 101179045890

ESI NUMBER

UNIT NAME : Omni-X Bending Pvt Ltd

DESIGNATION : Security Guard

APPLICANT NAME : RAMANNA G D

FATHERS'NAME DASAPPA

MOTHERA€ilS NAME

DATE OF BIRTH : 01-01-'1967

NOMINEE NAME : HAMABATHI

NOMINEE RELATION : WIFE

PERMANENT ADDRESS : H9,1ST CRO$ 3RD STA6E 4-H BLOCK,SI]AI(THI 6AMPAII1] liAGAR,,EAIIGAIORE l,lORTH MNGATORE ,B}SA![SH}1A'qANA6Afi MRM-IAI$.fiM79

DrsTRlcT (PINCODE) : Bangalore (560079)

MOBILE NO. : 7204184064

OUALIFICATION

BLOOD GROUP B+

HEIGHT

WEIGHT

CHEST 44

NATIONALITY

RELIGION : Hinduism

CAST

MARITAL STATUS : Married

LANGUAGES KNOWN . KANNADA..ENGLISH,TAMIL.HINDI

IDENTIFICATION MARK : BLACK EYES

TOTAL EXPERIENCE

EMERGENCY CONTACT NO. 1

EMERGENCY CONTACT NO.2

3rd Floor, 'lSth Cross, * Slsck, $ahakara Phore; *S*-?63?0114 €rnail: hr@squadindia.com

t'lagar. Hebbal, Sangalart, 56S09? Websile: www.squadindia.com

Cll! No. i GSI lN. 29MYCS457BA"IZP

r

"-

=w Squad lndia Secure Services Pvt Ltd

Enrollment Form

Name RAMANNA G D

Father's Name DASAPPA

Spouse Name. HAMABATHI
Personal No 7204184064
Date Of Birth & Age 01-01-1967
Rank Security Guard
Qualification GRAGUATED
Experience GRAGUATED
Present Address Permanent Address
Land Mark
NO 7 1ST MAIN ROAD KANAKA NAGAR
PATTEGARAPALYA NEAR GURUKULA
Land Mark ,ffitfJr?[?fii3lRo'Ji,o*5 filto*
INTERNATIONAL SCHOOL BANGALORE NORTH ,,BANGALORE NORTH BANGALORE
NAGARBHAVI BANGALORE KARNATAKA.560O72 ,bnsnvesuweRANAGAR KARNATAKA-560079
Villageffown
Villageffown : Basaveshwaranagar
Post Office :
. __..rst
Office
Taluka/Hobli : Basaveshwaranagar
Taluka/Hobli
: Karnataka State : Kamataka
State
District
Distrrct : Bangalore
. s60072 Pin code : 560079
Pin code
Languages Known : KANNADA.,ENGLISH,TAMIL,HINDI
Physical Standard
Height : Weight : Chest . 44

ldentification Marks
(i) BLACK EYES
(ii)BLACK HAIR
Marital Status / Name of SPouse : Married / HAMABATHI
Nominee. Relation
Reference (2 Neighbours with name, occupation and address / father-in-law-address)
1) HAMABAIHt -7022647217 -WIFE

t) 3)
t ..ft Thumb lmpression 1)

1) 2) 3)
Right Thumb lmPression

The above information is true to the best of my knowledge and belief.

zR,"\
11""((G-\t\

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\=a\-V isl

Recruitment Officer
Signature of the aPPlicant
Date :
Date :
 FORM - Q
(See Rules 24 9A\
APPOINTMENT ORDER
I Name & Address of The Establishment Squad India Secure Services Pvt Ltd
3rd Floor, l5th Cross, E Block, Sahakara Nagar,
Hebbal, Bangalore, 560092

2 Name & Address of the Employer Omni-X Bending Pvt Ltd

#20A12, I st Cross,,KIADB Road, Peenya Industrial
Area,,I Phase Bengaluru,Peenya I
Stage, Karnataka, Ind ia.

3 Name of the Employcc RAMANNA G D

4 His/her postal address NO 7 IST MATN ROAD KANAKA NAGAR

PATTEGARAPALYA NEAR GURUKULA
INTERNATIONAL SCHOOL BANGALORE
NORTH NAGARBHAVI BANGALORE
KARNATAKA-560072, Karnataka, India - 560072

5 His / Her permanent Address #O9,IST CROSS 3RD STAGE 4TH

BLOCK,SHAKTHI GANAPATHI NAGAR
,,BANGALORE NORTH BANGALORE
,BASAVESHWARANAGAR KARNATAKA-
56W7 9, Basaveshw aranagar, Bangalore, Karnataka,
India - 560079

6 Father's/liusband's Name DASAPPA

7 Date of Bifth Uuout967

!
8 Date of his/her entry in employment 1310212023

9 Designation Security Guard

10 Naturc of work entrustcd to him Securiry

I 1 His/her serial number in the Register of SIE 146 i

Employment

12 Rates of wages payable to him/her

. Basic+Da 15742.26 Rs. 16.680.66

' Other Allowance if Any Rs.950.00

Total Rs. 17,630.66

Place: Bangalore Signature of Employer

Date: : 1310212023 Seal of the Establishment

 FORM XIV Employment Card
(See Rule 76) (Under Contract Labour Act. 197 I )

Name and Address of the Contractor Name and address of Establishmenl to / under which conract is carried on
Squad India Secure Sewices Pvt Ltd Omni-X Bending Pvt Ltd
3rd Flmr. I5th Cross, E Block, Sahakara Naga', Hebbal, Bangalore,560092 #20Al2, lst Cross.,KIADB Road, Peenya Industrial Area",l Phase
Bengaluru,Peenya I Stage,Kamataka,lndia,

Nature of Work and location ofwork Name and address of principal Employer

Security Omni-X Bending pvr Ltd

Omni-X Bending Pvt Ltd #20Al2, I st Cross,,KIADB Road, Peenya lndusrial Area,,l Phase
#20Al2, lst Cross,,KlADB Road. Peenya lndustrial Area.,l Phase Bengaluru,Peenya I Bengaluru,Peenya I Stage,Kamataka"lndia,
Stage,Kamataka.lndia.

I Name of the Workman RAMANNA G D

2 Sl. No. in the register ofworkmen employed SIE | 46 I

3 Narurc of cmployment,/Dcsignation Sccurity Gurd SG

4 Wagc Rate (with particlars of unit in case of Rs. 1 7.610.66
piece-work)
5 Wage Period MONTHLY
6 Tenure of Employment PERMANENT
7 Renrarks

Signature of Contractor
 Squad lndia Secure Services Pvt Ltd
G/P POSTING / TRANSFER ORDER

No.
Date. 14-02-2023
POSTING / TRANSFER ORDER
To,
M/s Squad lndia Secure Services Pvt Ltd
3rd Floor, 15th Cross, E Block, Sahakara
Nagar, Hebbal, Bangalore, 560092

Employee Code: SlE1461 RAMANNA G D

You are hereby instructed that with effect from

you are posted/ transferred to

due to exigency of work. You

are required to intimate your unit in charge at hrs. and also your

arrival at the unit by Telephone to your concerned Area Manager/Officer or Manager (Rect
&Trg) in the branch office promptly. Failure to report in time at the designated place of duty or
non-compliance with the unit standing orders will violate the terms and conditions of service
and may necessitate disciplinary action.

For Squad lndia Secure Services Pvt Ltd

Signature of lndividual Branch/Area Manager Manager/Officer (Rec. & Trg)

(ln case of replacement - posting only)

Mr. Ticket no.

You are instructed to report to the branch office on for the collection of
your posting/ transfer order.

cc: to Unit ln charge

 I
FORM .'F'
NOMINATION

To,

M/s Squad lndia Secure Services Pvt Ltd

3rd Floor, 15th Cross, E Block, Sahakara
Nagar, Hebbal, Bangalore, 560092

1. Shri/Shrimati RAMANNA G D

Whose particulars are given in the statement below.l 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 the 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 name(s) of the nomrnee(s)

2. I hereby certify the person (s) mentioned is/are a member(s) of my family within the meaning of
clause (h) of Section (2) 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
controlling authority in terms of the provision to clause (h) of section 2 of the said Act.

6. Nomination made herein invalidates my previous nominations

NOMINEE'S

Name in full with full address of Relationship with the Age of Proportion by which the
Nominee(s) employee nominee gratuity will be shared
(1) (2) (3) (4\

I
 STATEMENT

1. Name Of the employee in full RAMANNA GD

2. Sex Male

3. Religion Hinduism

4.Whetherunmarried/married/widow/widower Married

5. Department Branch/Section where employed

6. Post held with Ticket No. Serial No. lf any

7. Date of appointment 13-Feb-2023

8. Permanent address

Village- Thana- . Sub Division-

Post Office- .. District- .. State- Karnataka

Place:
Signature/Thu mb lmpression
Date:
of the employee
Declaration by Witness

Nomination signed/thumb impressed before me

Name in full and full address of witnesses

Signature of witnesses
Place:

Date:
Certificate of the employer
Certified that the particulars of the above nomination have been verified and recorded in this
establishment

Employer's reference No,if any Signature of the employer/Office

authorized Designation

Date: Name address of the establishment

or rubber stamp there of
I
Acknowledgment by the employee
Received the duplicate of the nomination in Form 'F' Filled by me and duly certified by the employer

Date:

Signature of the employee

Note : Stri ke out words/parag raph not applicable

 FORM - 2 (Revised)
NOMINATION AND DECLARATION FORM
FOR EXCEMPTED/UNEXCEMPTED ESTABLISHMENT

Declaration and Nomination Form Under the Employment Provident Funds & Employees' Pension Scheme
(Paragraph 33 & 61 (1)of the Employee's Provident Fund Scheme,1952 & Paragraph 18 of the Employee's pension Scheme,1995

1. Name (ln Block Letters) : RAMANNA G D

2. Father's / Husband's Name : DASAPPA
3. Date Of Birth : 01-01-1967
4. Sex . Male
5. martial Status : Married
6. Account Number : 2529118002279
7. Address Permanenl : #0s,1sr cRoss 3RD srAGE 4rH BLocK,sHAKrHr cANApArHr NAcAR

remporary , H3Hififtlilffi;Br.r$L?f**'-Fo3#F.'3o[lHtifoft=o*
GURUKULA INTERNATIONAL SCHOOL BANGALORE NORTH
8' Date of Joining ilftP&-3R?1o*o^-o*.
' KARNATAKA-560072

EPF :

EPS :

PART-A(EPF)

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

Name & Address of Total amount of Share of lf the nominee is

Nominee's
minor name &
accumalation in provident
the Address relationship With the Date Of birth address &
fund to be paid to each
relationship of the
Nominee/Nominees member
nominee guardian
HAMABATHI
#79lA.1ST BLOCK
#79/A,1ST BLOCK WIFE 1979-10-26 't00%
SOMANAHALLI,BAN
GALORE SOUTH
BANGALORE
KARNATAKA.56OO82
SON/ANAHALLI.BANGAL OR

E SOUTH BANGALORE

KARNATAKA.56OO82

.Certify that I have

'1
. no family as defined in para 2 (g)of the Employee's Provident Fund Scheme '1 952 and should I acquire
a family hereafter the above nomination should be deemed as cancelled
2. .Certified that my father/mother is/ are depended upon me.

- Strlke out whichever

is not applicable. Signature or thumb impression of the Subscriber
 PART - B(EPS)

I here by furnish below particulars of the members of my family who would be eligible to receive widow/children pension in
the event of my death

Sl No Name of the family Members Address Date Of Birth Relationship

#79/A,.1ST BLOCK
1 HAMABATHI SOMANAHALLI,BANGALORE SOUTH 1979-10-26 WIFE
BANGALORE KARNATAKA.56OO82

Certified that I have no family as defined in para 2(vii) of the Employee's Pension Scheme 1995 and should I acquire a
family hereafter the above nominations should be deemed as cancelled

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

Name and address of the Nominee Date Of Birth Relationship with the member

Date :

Signature/ Thumb impression of the subscriber

CERTIFICATE BY EMPLOYER

Certified the the above declaration and nomination has been signed/thumb impressed before Shri/SmVKum
RAMANNA G D employed in my establishment after he/she has been read the entry/entries have been read over to
him/her by me and got confirmed by himiher

Place :
Date .
Designation.

Name and Address of the Establishment

 Undertaking

1) Certified the particulars are true to the best of my knowledge.

2) I authorize EPFO to use my Aadhar for verification/authentication/e-KYC purpose for service delivery.
3) Kindly transfer the funds and service details, if applicable, from the previous P.F account as declared above to the
present P.F.
Account as I am an Aadhar verified employee in my previous p.F. Account *
4) ln case of changes in above details, the same will be intimated to employer at the earliest.

Date : '13-02-2023
Place : Omni-X Bending Pvt Ltd, Karnataka Signature of member

DECLARATION BY PRESENT EMPLOYER

A" The Member Mr. /Ms. /Mrs, RAMANNA G D has joined on 13 Febru ary 2023 and has been allotted
PF number
B' ln case the person was earlier not a member of EPF Scheme 1952 and EpS,1995 :

i. (Post allotment of UAN)The UAN allotted for the member rs .,..,

ii. Please Tick the Appropriate Option:
The KYC details of the above member in the UAN database
Have not been uploaded
Have been uploaded but not approved
Have been uploaded and approved with DSC/e-sign
c. ln case the person was earlier a member of EpF scheme,1952 and EpS,19g5 ;

Please Tick The Appropriate Option :-

The KYC oetails of the above ntember in the UAN database have been approved with E-sign/Digital
Stgnature Cerlificate and transfer request has been generateo on potal
As the DSC of establishment are not regtstered With EPFO the member has been tnformed to file physical claim
i Form'l 3) for transfer of funds from his previousestablishment

Dale:13-02-2023 Signature of Employer with Seal of Establishment

L'
 emp code SlE1461

NgW FOfm NO-l 1 DeClafatiOn FOfm squad tndia secure seryices

Company Name
reference)
(To be retained by the Employer for future Pvt Ltd

EMPLOYEES' PROVIDENT FUND ORGANIZATION

The Employees' Provident Funds Scheme,1952(Paragraph - 34 & 57) &
Employees' Pension Scheme, 1 995 (Paragraph 24)
( Declaration by a person taking up employment in any establishment on which EPF Scheme, 1952 and / or EPS 1995 is applicable)

1 Name of the member RAMANNA GD

, Father's Name y' Spouse's Name
DASAPPA
' lPlease tick whichever is applicable )

3 Date Of Brrth: (DD/MM|YYYY) 01to1t1967

4 Gender:(Male/Female/Transgender) Male

5 Marrtal Status: (Married/UnmarriedAffidower/Divorcee) Married

(a)Emarl lD SlEl 46 1 @squadindia.com

6
(b) Mobile No : 7204184064
Whether earlier a member of Employees Provrdent Fund
7 Yes/No
Scheme. l 952

B. Whether earlier a member of Employees Pension Scheme, 1995 Yes/No

lf response to any or both of (7) & (8) above is yes. MANDATORY FILL UP THE (COLUMN 9)

(a) Universal Account Number

(b) Prevrous PF Account Number

L
(c) Date Of Exit Form Previous Employment

(d) Scheme Certificate No.

(e) Pension Payment Order(PPO)No

(a) lnternational Worker Yes/No

(b) lf Yes,state country of Origin

10.
(c) Passport No.

(d )Validity of Passport

KYC Details: (Attach self Attested copies of following KYCs)

(a) Bank Account No: 2529118002279

11. (b) IFS Code of the branch: cNR80010651

(c)AADHAR Number: 51 71 74508505

(d) Permanent Account Number(PAN),lf available AKXPR4847H

 EMPLOYEES STATE INSURANCE CORPORATION
FORM.1
To be Filled in by the employee after reading instructions overleaf .Two Postcard size photographs
are to be attached with this form.This form free of cost

(A) INSURED PERSON'S PARTICULARS (B) EMPLOYER'S PARTICULARS

l.lnsurance No 9.Employer's Code No stE146'l
2.Name (in block letters) RAMANNA G D Day Month Year
10.Date Of Appoinment
IJ o2 2023
3.Father's/Husband's Name DASAPPA
11.Name and Address Of the Employer
D M I v I 5Marrial Squad lndia Secure Services Pvt Ltd
4 Date Of Birth ,V 3rd Floor, 15th Cross, E Block, Sahakara Naqar, Hebbal, Banqalore,560092
o'l or ],sozl sratus
6. Sex Male '12.|n case any previous employment please fill up the details as under:-

T.Present Address 8.Perrnanent Address a).Previous lns.No

NO 7 1ST MAIN ROAD KANAKA NAGAR #09 1ST CROSS 3RD STAGE 4TH a).Emplr's Code No
PATTEGARAPALYA NEAR GURUKULA ALOCK SHAKIHI GANAPATHI NAGAR 11.Name and Address Of the Employer
INTERNATIONAL SCHOOL BANGALORE ..BANGALORE NORTH BANGALORE Squad lndia Secure Servrces Pvt Ltd
R6ffi ?fl 9o ?o*o o, o *. El{SQ[t ,*^?QRQER* **n oro*-ruoo,n 3rd Floor. 15th Cross, E Block, Sahakara Nagar, Hebbal, Bangalore,560092
"^*[Q,RQ/
r&srorh qilE6d&1 @squadin dia.com Email SlE1461@squadindia.com address : hr@squadindia.com
lemail I

Branch Office Dispensary

(C) Details of Nominee u/s 71 of ESlAct 1948 lRule 56(2) of ESI (Central) Rules , 1950 for payment of cash benefit in
the event of death
Name Relationship Address
#79/A,1ST BLOCK SOMANAHALLI,BANGALORE SOUTH BANGALORE
HAMABATHI WIFE
KARNATAKA-56ff}82

I hereby declare that the particulars given by me correct to the best of my knowledge and belief.l undertake to intimate the corporation any changes in the
membership of my family within 15 days of such change.

Counter signature by the employee Signatureff.l. of lP0

Siqnalure with Seal

(D)FAMILY PARTICULARS OF THE INSURED PERSON

Date of Birth
/Age as on date

26-10-1979 I 43

ESI Corporation Temporary ldentity Card

name
lns.No Date of Appointment
Branch Office Dispensary
Employer's Code No
& Address

Dated SignatureiT.l of lP Signature of B.M with seal

 1. Submission of Form - 1 is regulations 1 1 & 12 of ESI (General) Regulations,'1950.
2."Family" means all or any of the following relatives of an lnsured Person namely:-
(i). A spouse (ii) a minor legitimate or adopted child dependant upon the l.P (iii)a child who is wholly dependent on the
earnings of the l.P and who is (a)recieving education,till he orshe attains the age of 21 years (b)an un married
daughter;(iv) a child who is infirm by reason of any physical or mental abnormity or injury and is wholly dependent on the
earnings of the l.P.so long as the infirmity continues; (v)dependent parents(Please see Section 2 clause 11 of the ESI
Avt '1948 for details)
3. ldentity card is Non-transferable
4. Loss identity card be reported to Employer/Branch Manager immediately
' 5. Submission of false information attracts penalaction under Section 84 of ESlAct,1948
6. This form duly filled in must reach the concerned Branch office within 'l 0 days of appointment of an Employee.Delay
attracts penal action under section 85 of the Act,against employer
7. As an insured person you and your dependent family members are entitled to full medical care.The benefits in cash
include (1) sickness benefit (2) Temporary Dlsablement benefit (3) Permanent Disablement Benefit (4) Dependents
benefit and (5) Maternity Benefit(incase of women employees subject to fulfillment of contributory conditions
8. For more details Please Visit Website of ESIC at www.esic.nic.in or wr,rrw.esickar.gov.in contact Regional office or
Branch Office

FOR BRANCH OFFICE USE ONLY

Date of Allotment of lns.No :

Date of issue of TIC :

Name/No .of Disp :

Whether reciprocal Medical arrangements involved? if yes please indicate :

Signature of Branch Manager

st. Date of Birth Relationship with Whether !f 'No' state place of

Name /Age as on date residing with
NO of fillinq form Employee him/her Residence
yes No Town State

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SQUAD
SECURE
If\n t}il&
SERVICES PVT. LTD.

I
T

ffiA&,#,,eruru,& fi *
Securitv Guard
Employee ID : SIE 146l
D.O.J : 14t02t2023
Volidity Upto : 14t02t2024
Blood Group
Signoture of employee Authorised Signotory

If found pleose return to

a
a

# 2831, 3rd Floor, lSth Moin

2nd Cross, E Block
Sohokor Nogor, Hebbol
Bongolore - 560092
Ph: 080 23620114