Chaukidaar Cum Sweeper Registration Form

UAN Number				(PHOTO)
Name
Project Applying For
Role Applying For
Date of Birth (DD-MM-YYYY)		Contact No
Father / Husband Name
Mother Name
Address
Email ID

EMPLOYMENT PROFILE (OPTIONAL)

Company	Designation	Date of Joining	Date of Leaving	Total Years

PERSONAL INFORMATION

Aadhaar Number		PAN Number
UAN Number		ESIC Number
Name as per Aadhaar
Aadhaar Card (PDF)
PAN Card (PDF)
EPFO Passbook (PDF)
Nominee Name		Relation

BANK ACCOUNT DETAILS

Account Holder Name
Account Number		IFSC
Bank Name		Branch
MICR Code
Bank Passbook (PDF)

Declaration: I hereby declare that the information provided above is true to the best of my knowledge.

Employee Signature

Date