BACKGROUND CHECK FORM Business Associates (BA)

Guidelines /Checklist
• Fill-up the BGC Form completely and accurately with copies of all relevant supporting documents as proof
• ‘Unable to Verify’ due to incorrect or incomplete information furnished by you may lead to delays and/or
unsuccessful completion of BGC
• Ensure consistency in information furnished by you initially in TCS Application Form
______________________________________________________________________________________

(1) Tick on the boxes below before submitting the BGC form, ensuring that you have submitted all required documents.
(2) No BGC forms will be accepted in the absence of any of the required documents as mentioned below.

Mandatory General Requirements:

 Signed & Attached Document on General Consent to Background Investigation Letter

(BGC Consent Letter enclosed within the BGC form)
 My recent Passport size photograph pasted at the appropriate place

Address Check & Criminal Check Requirements:

 Complete & Correct Address filled-in as required in BGC Form with Flat/Room No. clearly mentioned
 Prominent landmark near the address mentioned for easy location
 Self-attested & signed - Document for Address Proof submitted

• What could be submitted for Address Proof?

o Proof for Present & Permanent Address to be attached
o Provide Separate Proof, if address is different
o Attach copy of any one of the following documents as Proof for Address

(a) Ration Card (b) Electricity Bill (c) Landline Telephone Bill (Mobile ph bill not acceptable)
(d) House Lease Agreement (e) Aadhar Card

o Address Proof – For House Lease Agreement

 Copy of Agreement submitted (If Agreement signed between you and Owner)
 Copy of Agreement + Declaration Letter in Stamp Paper from Agreement Holder
(Blood Relation) stating that I am residing in the same address as mentioned in the
Agreement (If Agreement signed between your Family Member (Blood Relation)
and Owner)
 Letter from Society of the address (If Agreement signed between any other person
(Non-blood Relation) or you are staying in Bachelor’s Accommodation)
Note: For all House Lease Agreements, you should have stayed at least 6 months in the Address
mentioned and the Agreement should be valid and within the expiry date
 Separate CID Form filled in & attached for each different address (For Applicants from Mumbai, Thane
City, Thane Rural & Pune - Full Addresses and Signature given in each)
Note: Forms not signed by the Applicant are not accepted by the Police for verification.

Applicants to report at Police station when called for as part of verification process by Police

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 1 of 14
Ensure consistency with information furnished by you initially to TCS
 ID Check Requirements

 Self-attested & signed - Document for ID Proof submitted

• What could be submitted for ID proof?

(a) Valid Passport (b) Driving License (c) PAN Card (d) Aadhar Card (e) Voter’s ID card

Reference Check Requirements – For each Reference

 References provided are either Supervisor/HOD / Professor / TPO/Person holding Responsible Position
in a reputed Organization
o No Relatives/Friends to be mentioned
o Reference to know Applicant for a minimum period of 2 years
 Full Name & Address of References provided legibly
 Contact email ID & telephone numbers of References provided
o Provide atleast two contact numbers

Educational Check Requirements

 Self-attested & signed – copies of Highest Degree /Provisional Degree submitted

 Self-attested & signed – copies of all Highest Degree mark sheets attached

Previous Employment Check Requirements:

 Self-attested & signed – copies of the documents from BA Company

o BA Deputation letter – Mandatory
o Last three months salary slip
 Self-attested & signed - Documents for all Previous Employment Proof submitted

• What could be submitted for Previous Employment Proof?

o Relieving Certificate from your Previous Employer(s) - Mandatory
o Experience Certificate & Salary Certificates – Last 3 months - Mandatory

Note: Your BGC Status will be Positive only after successful completion of employment checks
Including your Current Employer

Gaps during Education / Employment Check Requirements:

 Self-attested & signed – Documents to explain gaps during Education/Employment

• What could be submitted as Proof for gaps during Education/Employment?

o Medical records for gaps due to medical reasons
o Affidavit with Notary Authorization for gaps due to other Personal reasons
Applicant to please detach and destroy this checklist while submitting the completed BGC Form

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 2 of 14
Ensure consistency with information furnished by you initially to TCS
BACKGROUND CHECK FORM Business Associates (BA)
Paste your
TCS BA No.: Have you served as BA in TCS earlier? recent Passport
(For Office Use Only) YES / NO Size Photo here
If yes, mention your BA No. assigned
earlier :

BA Company Name: Diverse Lynx India Pvt. Ltd. TCS Branch Joined:

Designation: Business Associate Date of joining:

Name of the Applicant (Full name expanding initials): Sthir Kumar

Contact Landline Phone no.: Mobile Phone no. 9557044730 email id: [email protected]

Father’s Name: Bijendra Kumar

Date of birth (Attach Proof): Marital Status: Single Nationality: Indian

10/08/1991
PAN No : CRNPK3313C Aadhar No : 348688027745

A. Present Residential Address : (Attach Proof)

Period of Stay From : To: Present Landmark: Aman Palace
01/08/1991
H-no 10 , Dhaiya wali Gali, Sector 17A ,

City/Town: Gurgaon State: Haryana Pin code: 122001

B. Other Residential Address: [Furnish other addresses of your residence in the last seven (7) years]
Other Residential Address 1: Other Residential Address 2: Other Residential Address 3:
From : To: From : To: From : To:
01/10/2014 31/07/2018
H-9 Second Floor, Sector 11

City/Town: Noida City/Town: City/Town:

State: UP State: State:
Pin code: 201301 Pin code: Pin code:
Landmark: Landmark: Landmark:
Attach Additional Sheet, if you have stayed in more than 3 Other Residential addresses (locations)
C. Permanent Address: (Attach Proof)
Period of Stay From : 01/05/1991 To: Present Landmark:
H-no 289/18 , Slivalic Lane, Patti chaudhran

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 3 of 14
Ensure consistency with information furnished by you initially to TCS
 City/Town: Baraut State: UP Pin code: 250611
Contact Landline Phone no.: Mobile Phone no.:
A) Are you involved in any pending and / or closed Civil / Criminal / case / proceedings /
charges / enquiry prior to joining TCS ?
Yes / No
B) Are you involved in any pending and / or closed Disciplinary / malpractices and / or any
other charges / proceedings / enquiry / case pending against me in any University or any
other educational authority / institution prior to joining TCS ?
Yes / No
C) If the answer to any of the above mentioned questions is ‘ Yes’ give full particulars of the case /arrest / detention
/ fine / conviction / sentence / punishment etc. and / or the nature of the case pending in the Court / University /
Educational Authority etc., at the time of filling up this form.(Attach additional sheet, if required)

Reference Details:
Details Reference 1 Reference 2
Reference Name (No Relatives/Friends
to be given as Reference)
Title & Designation:
(Supervisor/Person holding responsible
Position in a Reputed Organization.):
Is the above mentioned Reference/
Supervisor from the current Company Yes / No Yes / No
Full Address (with Company Name):

Contact details Official email ID:

Landline Telephone No.:

Mobile Phone No.:

Period for which the Reference knows the

Applicant (Minimum 2 years)
Relationship with the Applicant
(No Relatives/Friends)
Passport Details (Attach Proof):

(i) Name as in Passport: ______Sthir Kumar__________________________________________________

(ii) Passport No : __________P4736693________ (iii) Place of Issue : __________Ghaziabad________

(iv) Date of Issue : _______07/09/2016_________ (v) Date of Expiry : _________06/09/2026_________

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 4 of 14
Ensure consistency with information furnished by you initially to TCS
TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 5 of 14
Ensure consistency with information furnished by you initially to TCS
Educational Qualifications (Attach Proof)
Name as in Certificate: __________________________________________________________________________

Qualification Highest Degree Qualification prior to Highest Degree

Mode of Education
(Full time/Correspondence/Partime):
Full Time Full Time
Name of Examination Passed (B.E./M.Tech, etc.): B.Tech Senior Secondary
Computer Science and Engineering Physics, Chemistry , Mathematics
Specialization / Main Subjects:

Bharat Institute of Technology Krishna Public School

Name of Institute / College /
University:

Address: NH-58, Partapur Bypass NH-58, By Pass, Shradha Puri,

(Give Complete Address)
Kanker Khera

Institute / City/Town: Meerut City/Town: Meerut

College /
University State: UP State: UP
Details Pin code: 250103 Pin code:250001
Landmark: Landmark:
Office Landline Ph No.:
Name of Affiliated University: Uttar Pradesh Technical University Central Board Of Secondary
Education
Affiliated University Lucknow Delhi
Location:
Date From: May 2009 May 2008
Period of Study Date To: May 2013 May 2009
Seat No. / Roll No./ Regn No.: 0912810109 5743022
Year of Passing: 2013 2009

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 6 of 14
Ensure consistency with information furnished by you initially to TCS
% of marks & Class / Grade obtained: 56.4 64.4

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 7 of 14
Ensure consistency with information furnished by you initially to TCS
Employment Details (Starting from your Current/Immediate Last Employment) (Attach Proof):
Name of the BA Company : Diverse Lynx India pvt. Ltd.

Previous Employer’s Description Current BA Company Previous Employment 1

Period Date of emp. From: 13/08/2014
Date of emp. To:
Employee Designation: Software Engineer
Details Employee #: Sthir Kumar
HR HR Name: Prashant Saxena Shalini Singh
Details HR Designation: Head recruitment Senior Manager Human Resource
Office Landline Ph No.: 120-4604506 Do not provide Mobile Ph No 91-124-4302 000 Do not provide Mobile Ph No
Email: [email protected] [email protected]
Supervisor Supervisor Name: Pramod Goswami
Details Supervisor Designation: Project Manager Technical
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email: [email protected]
Last drawn CTC: 288577
Reasons for leaving: To work on new Technologies and
frameworks
Employer Employer Name: Diverse Lynx India pvt. Ltd. C1 India Pvt Ltd
Details
Address: A-4&5, Logix park, Plot Number 301,
(Give Complete 1st Floor
Address incl. Postal
code, prominent
landmark) Sector -16 Udyog Vihar Phase – 2

Town/City: Noida Town/City: Gurgaon

State: Uttar Pradesh Pin Code: 201301 State: Haryana Pin Code: 122015

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 8 of 14
Ensure consistency with information furnished by you initially to TCS
Office Landline Ph No.: Do not provide Mobile Ph No 91-124-4302 000 Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 9 of 14
Ensure consistency with information furnished by you initially to TCS
 Previous Employer’s Description Previous Employment 2 Previous Employment 3
Period of Date of emp. From:
employment Date of emp. To:
Employee Designation:
Details Employee #:
HR Details HR Name:
HR Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Supervisor Supervisor Name:
Details Supervisor Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Last drawn CTC:
Reasons for leaving:
Employer Employer Name:
Details
Address:
(Give Complete Address
incl. Postal code,
prominent landmark)

Town/City: Town/City:
State: Pin Code: State: Pin Code:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 10 of 14
Ensure consistency with information furnished by you initially to TCS
 Previous Employer’s Description Previous Employment 4 Previous Employment 5
Period of Date of emp. From:
employment Date of emp. To:
Employee Designation:
Details Employee #:
HR Details HR Name:
HR Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Supervisor Supervisor Name:
Details Supervisor Designation:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Email:
Last drawn CTC:
Reasons for leaving:
Employer Employer Name:
Details
Address:
(Give Complete Address
incl. Postal code,
prominent landmark)

Town/City: Town/City:
State: Pin Code: State: Pin Code:
Office Landline Ph No.: Do not provide Mobile Ph No Do not provide Mobile Ph No
Company Status: Is company currently functioning? Yes / No Is company currently functioning? Yes / No
Note: (i) You may attach additional sheets, if required, to provide more details on your Previous Employments

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 11 of 14
Ensure consistency with information furnished by you initially to TCS
 Declaration and General Consent to Background Investigation

Declaration to be signed by the BA

In connection with rendering services to Tata Consultancy Services Ltd. (the "Company"), as a Business
Associate (BA) from
__________________________________________________________________________(BA Company),

I hereby agree as follows:

I certify that the information furnished in this form as well as in all other forms filled-in by me in conjunction
with my rendering of services as a BA is factually correct and subject to verification by TCS including
Reference Check and Background Verification.

I accept that my services as a BA can be revoked and/ or terminated without any notice at any time in future
if any information has been found to be false, misleading, deliberately omitted/ suppressed.

As a condition of Company's consideration of my rendering of services as a BA to the Company, I hereby

give my consent to the Company to investigate or cause to be investigated through any third parties my
personal, educational and pre or post employment history, criminal history and any other checks, including
Drug test as required for complying with TCS and or Client specific BGC requirements. I understand that the
background investigation will include, but not be limited to, verification of all information given by me to the
Company. I confirm that the Company is entitled to share such investigation report with its clients to the
extent necessary in connection with the Services, which I may be required to provide to such clients. I
confirm and undertake that the Company shall incur no liability or obligation of any nature whatsoever
resulting from such investigation or sharing of the investigation results as above.

I certify that I am at present in sound mental and physical condition to undertake my rendering of services as
a BA with TCS. I also declare that there is no criminal case filed against me or pending against me in any
Court of law in India or abroad and no restrictions are placed on my travelling anywhere in India or abroad for
the purpose of business of the company.

I hereby declare and undertake that

I shall not resort to any unethical, unfair practices to augment my chances of selection with TCS by adopting
unlawful means directly and / or indirectly within and outside TCS and shall strictly adhere to the selection
process made applicable by TCS

My candidature for Contract Services in the Company is liable to be rejected in the event it comes to the
knowledge of TCS that I have resorted to unethical, unfair practices to augment my chances of selection with
TCS. I am fully aware that TCS is an equal opportunity employer and the decision of TCS to hire me is solely
will be made on my credentials duly validated and on the assessment of my capability to perform a role for
which I am interviewed by TCS.

I Agree : Yes

Signature :____________________ Name :_________Sthir Kumar____________________

Place :____Gurgaon_________ Date :__________06/08/2018____________________

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 12 of 14
Ensure consistency with information furnished by you initially to TCS
Gaps during Education/Employment (Attach Proof):
From To Reasons for gap

Gap Period 1

Gap Period 2

DECLARATION (To be signed by the Applicant)

I certify that the information furnished in this form is factually correct and complete in all respects to the best
of my knowledge and belief.

Signature of Applicant _____________________ Name ___________________________

Place _____________________ Date ___________________________________

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 13 of 14
Ensure consistency with information furnished by you initially to TCS
 Please attach the following documents along with this Background Check Form:

(a) Your recent Passport size photograph pasted at the appropriate place

(b) Self-attested & Signed Copy of Identity Proof document:

• Valid Passport / Driving License / PAN Card / Voter’s ID card

(c) Self-attested & Signed Copy of Address Proof document:

• Ration card / Electricity bill / Landline Telephone bill /
• House Lease Agreement + Related Documents as required

(d) Self-attested & Signed Copy of Educational Certificates:

• Highest Degree Certificate(s) /Provisional Degree Certificate(s)
• Highest Degree Mark sheets of all exams

(e) Self-attested & Signed Copy of Employment documents:

• BA Company Deputation Letter & last 3 months salary certificate

• Previous Employment
(i) Relieving Certificate(s) (ii) Experience Certificates(s)
(iii) Salary Certificates – Last 3 months

(f) Self-attested & Signed – Documents to explain gaps during Education/Employment

• Attach Affidavit with Notary Authorization for gaps

(Please refer Background Check Form Guidelines/Checklist in Pages 1& 2 for more details)
For Office Use Only:
Verified the following:

 BGC Consent Letter – signed & attached

 Recent Passport size photo pasted at the appropriate place
 BGC Form filled-in with all complete details
 Address & ID Proof documents self-attested, signed & attached
 Highest Degree Certificate(s)/Provisional Degree Certificate(s) – copies self-attested, signed & attached
 Highest Degree Mark sheets of all exams – copies self-attested, signed & attached
 BA Company deputation letter and salary certificates
 Previous Employment documents –, Relieving Certificates, Experience Certificates, Salary Certificates
 Documents to explain gaps during Education/Employment – attached

RMG Head/RMG BA BGC SPOC :

Name: _______________________ Emp # : ____________ Signature : ________________ Date: _________________

TCS Confidential Background Check Form – Business Associates (BA) Version 7.0 Page 14 of 14
Ensure consistency with information furnished by you initially to TCS