KR Elixir Private Limited
EMPLOYEE ON-BOARDING INFORMATION
1. Emp No:
2. Full Name: GURUPRASAD B
3. DOB: 08/12/1992
4. Aadhar No: 969409319520
5. Gender(F/M): MALE
6. Reporting Manager:
7. DOJ: 12-05-2025
8. Status (Internal/External): Internal
9. Referred By: ______________________________________________
10. Probation Period: __________________________________________
11. Confirmation Date: _________________________________________
13. Mob No: 8073600389
14. Emergency Contact Name: Vinayaka
15. Emergency Contact No: 9964650460
16. Father’s Name: Ramanathappa
17. Spouse :
Note:- Columns in red are to be filled by the HR
PERSONAL INFORMATION
1) Blood Group: B +ve
2) Marital Status: SINGLE
3) Marriage Date:
4) Nationality: INDIAN
5) Residential Status (Non Resident/Indian Resident): Indian Resident
6) Place of Birth: SORABA
7) Country of Origin: INDIA
8) Religion: HINDU
Present Address :-
DOOR NO: 65 NEAR BY HAMPI NAGAR POST OFFICE VIJAYANAGAR BENGALURU
___________________________________________________________________
City: BENGALURU Pin Code: 560104 State: KARNATAKA
Permanent Address :-
DOOR NO: 197 WARD NO: 8 CHIKKAPETE SORABA
City: SORABA Pin Code: 577429 State: KARNATAKA
Emergency Address:-
DOOR NO: 65 NEAR BY HAMPI NAGAR POST OFFICE VIJAYANAGAR BENGALURU
__________________________________________________________________
City: BENGALURU Pin Code: 577429 State: KARNATAKA
Have you resided abroad ? If Yes Where Period
Passport No: Issued At: Valid Upto:
_______
Driving License No : Issued At: Valid Upto:
______
FAMILY DETAILS
Relationship Name DOB Contact Blood Group Nationality
Father RAMANATHAPP 06-05- B +VE INDIAN
A 1965
Mother SHASHIKALA 01-01- 9964650460 A +VE INDIAN
1970
Brother / Sister RAJATH 14-09- 7411782854 AB +VE INDIAN
1994
Husband/ Wife
Children 1
Children 2
JOINING DETAILS
1) Joined On: __12-05-2025_________
2) Confirmation Date: ______________
3) Status :- ______________________
4) Probation Period: _____________
5) Notice Period: __________________
6) Referred By:__________________
7) Total Experience till date:- 7 YEAR 5 MONTH
8) Relevant Experience:- 7 YEAR 5 MONTH
9) Other Experience: _____________________
WORK EXPERIENCE
(Give present or most recent employer first)
Name Period from Position of Manager Reason for Last
and Details Leaving drawn
Address (Email & Salary
From To Start Leave
of Mob) (CTC)
Employer
with Emp
Code
AUG-03- July AUG-03- July BALA Due to 4,36,65
EVRY 2015 13, 2015 13, MURUGAN change in 5/-
INDIA 2018 2018 988033456 office
1 location
7410
Novemb July Novemb July MURALIDH LOOKING
HAPPIES er 21, 17, er 21, 17, AR FOR 8,00,00
T MINDS 2018 2020. 2018 2020. 974235149 BETTER 0/-
4 OPPURTUNI
TY
Decemb May Umashank Due to 18,00,0
BRILLIO Decemb May er 09, 03, ar health 00/-
er 09, 03, 2021 2024 974298861 issues
2021 2024 2
Septem Januar Septem Januar Nisha Due to 24,00,0
CAPGEMI ber 30, y 23, ber 30, y 23, 982027143 Relocation 00/-
NI 2024 2025 2024 2025 6 issues
REFERENCES (Other than Relatives)
Name Designation Company Address Contact Email Id
Note:- Columns in red are to be filled by the HR
EMPLOYEE POSITION
1) Division : ________________________
2) Cost Centre: ______________________
3) Grade: ___________________________
4) Designation: senior java developer______
5) Location : Bengaluru
6) Department : ____________
7) Emp Category (Offshore/Onsite): Offshore ____
8) Employee Skills: JAVA, SPRINGBOOT, MICROSERVICE
9) Certifications : NONE
EDUCATION
Qualification From To Institute Grade Qualification Area
BE AUG-2011 AUG- PESITM FIRST INFORMATION
2015 COLLEGE OF CLASS SCIENCE AND
ENGINEERING ENGINEERING
12TH MAR-2009 MAR- HONGIRANA FIRST PCMC
2011 INDEPENDENT CLASS
PU COLLEGE
10TH MAR-2008 MAR- GPUC FIRST
2009 COLLEGE CLASS
SORABA
SPECIALIZED TRAININGS & CERTIFICATIONS, OTHER QUALIFICATIONS
(Diploma Courses, Short courses, Certification Courses)
Name of Institute Qualification Certification Date
Note:- Columns in red are to be filled by the HR
EMPLOYEE IMPORTER FORM
Employee No
Name GURUPRASAD B
DOB 08/12/1992
Gender MALE
Contact No 8073600389
Personal Email Id [email protected]
Marital Status SINGLE
Blood Group B+VE
Father Name RAMANATHAPPA
Emergency Contact Name VINAYAKA
Emergency Contact No 9964650460
PAN No BRRPG3743B
Aadhar Card No 969409319520
Bank A/C No 50100404501397
IFSC Code HDFC0001208
Bank Account Type CURRENT ACCOUNT
Bank Name HDFC
Bank Branch MILLER ROAD BENGALURU
Salary Payment Mode (Cheque/Cash/DD/Bank
Transfer)
Is employee eligible for PF? (Y/N) Y
UAN No 100576728558
Is existing member of PF?(Y/N) Y
Country Of Origin INDIA
Joining Date 12/05/2025
Designation SENIOR JAVA DEVELOPER
Location BENGALURU
Department IT
Employee Number Series
Probation Period 3 months
Manager's Employee No
Employee Status
Note:-
Columns in red are to be filled by HR
Please ensure the columns contain data in the proper format. For example, date
values or numeric values should be correct
Employee Signature Date
12/05/2025
PF ADDITION DELETION FORM
Universal Account Number (UAN) 100675728558
Previous Member Id MHBAN001873400006921
73
Member Name GURUPRASAD B
Date of Birth 08/12/1992
Date of Joining 12/05/2025
Gender MALE
Father/Husband Name RAMANATHAPPA
Relationship with the Member father
Mobile Number 8073600389
Email Id
[email protected]Qualification BE
Marital Status SINGLE
Nominee 1 & Mobile no SHASHIKALA , 7411782854
Nominee 2 & Mobile No RAJATH, 9964650460
Passport Number M7937034
Passport Valid From Date 06/04/2015
Passport Valid Till Date 05/04/2025
Bank Account Number 50100404501397
Bank IFSC HDFC0001208
Name as per Bank Details GURUPRASAD B
PAN BRRP3743B
Name as on PAN GURUPRASAD BOMBORE
AADHAAR Number 969409319520
Name as on AADHAAR GURUPRASAD B
IS pension contribution made in old PF Account YES
Remarks
KRE ID CARD FORMAT
Sr. No KRE Employee ID Employee Name DOJ KRE Job Title Contact Employee Office
(Designation) Number Photo Location
GURUPRASA 12/05/2 SENIOR 807360 YES HSR
D.B 025 JAVA 0389 LAYOUT
DEVELOPE
R
1. Passport size photograph with white background, JPEG format.
Payment of Gratuity (Central)
Rules
FORM 'F'
See sub-rule (1) of Rule 6
Nomination
To
KR Elixir Technology. #57,
12th Main Road, Sector 6,
HSR Layout Bengaluru,
Karnataka - 560102, India.
I, Shri GURUPRASAD.B
(Name in full here)
whose particulars are given in the statement below, 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 that
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 nominee(s).
2. I hereby certify that 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 12/05/2025
the controlling authority in terms of the proviso to clause (h) of Section 2 of the said Act.
6. Nomination made herein invalidates my previous nomination.
Nominee(s)
Name in full with full Relationship with Age of Proportion by which
address of nominee(s) the employee nominee the gratuity will be
shared
(1) (2) (3) (4)
1. Shashikala mother 55 100
2.
3.
Statement
1. Name of employee in full: GURUPRASAD B
2. Employee Id
2. Sex _MALE___________________________________________________________________
3. Religion: HINDU_________________________________________________________________
4. Whether unmarried/married/widow/widower: unmarried
5. Department/Branch/Section where employed KRE
6. Post held with Ticket No. or Serial No., if any NA
7. Date of appointment ___12-05-2025__________________________________________________
8. Permanent address: door no: 197 ward no: 8 chikkapete soraba, shimoga (D)
Village : Soraba Thana : Soraba Sub-division
Post Office: soraba District :shimoga State _KARNATAKA_________
Place: BENGALURU
Signature/Thumb-impression of the employee
Date: 12/05/2025
Declaration by Witnesses
Nomination signed/thumb-impressed before me
Name in full and full address of witnesses. Signature of Witnesses.
1. 1.
2. 2.
Place:
Date:
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 Signature of the employer/Officer
authorised
Designation
Date: Name and address of the establishment or rubber stamp
thereof.
Acknowledgement by the Employee
Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer
Date
Signature of the Employee
______________________
New Form : 11 - Declaration Form
(To be retained by the employer for future reference)
EMPLOYEES' PROVIDENT FUND ORGANISATION
Employees' Provident Fund Scheme, 1952 (Paragraph 34 & 57) and
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking up Employment in any Establishment on which EPF Scheme, 1952 and for
EPS, 1995 is applicable)
GURUPRASAD. B
1. Name of Member (Aadhar Name)
Father's Name Spouse's Name RAMANATHAPPA
2.
(Please tick whichever applicable)
3. Date of Birth (dd/mm/yyyy) 08/12/1992
4. Gender (Male / Female / Transgender) MALE
5. Marital Status ? (Single/Married/Widow/Widower/Divorcee) SINGLE
6.
(b) Mobile No (Aadhar Registered) 8073600389
Whether earlier member of the Employee's Provident Fund
7. Yes
Scheme, 1952 ?
Whether earlier member of the Employee's Pension
8. Yes
Scheme, 1995 ?
Previous Employment details ? (If Yes, 7 & 8 details above) 100675728558
a) Universal Account Number (UAN)
9.
b) Previous PF Account Number MHBAN00187340000692173
c) Date of Exit from previous Employment ? (dd/mm/yyyy) 23/01/2025
d) Scheme Certificate No (If issued)
e) Pension Payment Order (PPO) (If issued)
a) International Worker No
10. b) If Yes, state country of origin (name of other country)
c) Passport No.
d) Validity of passport (dd/mm/yyyy) to (dd/mm/yyyy)
KYC Details : (attach self attested copies of following KYC's)
11. a) Bank Account No. & IFS Code 50100404501397
HDFC0001208
b) AADHAR Number 969409319520
c) Permanent Account Number (PAN), If available BRRPG3743B
After Sep 2014 earned
First EPF First Employment EPF Are you EPF If Yes, EPF If Yes, EPS (Pension)
EPS (Pension) Amount
12. Wages Member before Amount Withdrawn?
Member Amount Withdrawn before Join
01/09/2014 current Employer?
Enrolled Date Withdrawn?
01-FEB-2016 EVRY INDIA PVT LTD
No No No No
UNDERTAKING
1) Certified that the particulars are true to the best of my knowledge
2) I authorise EPFO to use my Aadhar for verification / authentication / eKYC purpose for service delivery
3) Kindly transfer the fund and service details, if applicable, from the previous PF account as declared above to the present PF account.
(The transfer would be possible only if the identified KYC details approved by previous employer has been verified by present
employer using his Digital Signature 4) In case of changes in above details, the same will be intimated to employer at the earliest
Date : 12/05/2025
Place : BENGALURU Signature of Member
DECLARATION BY PRESENT EMPLOYER
A. The member Mr./Ms./Mrs. ……………..…………………….. Has joined on ……………………….and has been alloted PF Number ……….…
B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995: ((Post allotment of UAN) The UAN
alloted or the member is) Please Tick the Appropriate Option : The KYC details of the above member in the JAN
database
Have not been uploaded Have been uploaded but not approved Have been uploaded and approved with DSC
C.
In case the person was earlier a member of EPF Scheme, 1952 and EPS 1995;
The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate
and transfer request has been generated on portal
As the DSC of establishment are not registered with EPFO, the member has been informed to file physical claim (Form-13) transfer of
funds from his previous establishment.+
Date : Signate of Employ er with Seal of Establishment
Employees Provident Fund Scheme
Form 2
Paragraphs 33 & 61(1) of the Employees Provident Funds Scheme, 1952 and
Paragraph 18 of the Employees’ Pension Scheme, 1995
Nomination and Declaration Form for Unexempted
Exempted Establishment
Declaration and Nomination Form under the Employees’ Provident Funds
and Employees’ Family Pension Schemes
1. Name GURUPRASAD.B
(in block letters)
2 Father’s / Husband’s Name RAMANATHAPPA
3 Date of Birth: 12/05/1992
4 Sex : MALE
5 Marital Status: SINGLE
6 Account No: 50100404501397
7 Address:
Permanent DOOR NO: 197 WARD NO: 8 CHIKKAPETE SORABA SHIMOGA
Temporary: DOOR NO: 65 NEAR BY HAMPINAGAR POST OFFICE VIJAYANAGAR
NAGAR
8 (A) Date of Joining of EPF Scheme, 1952: 01-FEB-2016
(B) Date of Joining of EPF Scheme, 1971: 01-FEB-2016
(C) Date of Joining of EPF Scheme, 1995: 01-FEB-2016
Part A (EPF)
I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the
person(s), mentioned below to receive the amount standing to my credit in the Employees’ Provident
Fund, in the event of my death:
Name of the Address Nominee’s Age of Total amount If the Nominee is a
nominee/no relationship Nominee(s) or share of minor, name &
minees with the accumulation relationship & address
member s in Provident of the guardian who
Fund to be may receive the
paid to each amount during the
nominee minority of nominee
1 2 3 4 5 6
SHASHIKAL DOOR NO: MOTHER 55 100
A 197 WARD
NO: 8
CHIKKAPET
E SORABA
SHIMOGA
1. *Certified that I have no family as defined in Para 2(g) of the Employees’ Provident Funds Scheme, 1952
and should I acquire a family hereafter the above nomination should be deemed as cancelled.
2. *Certified that my father/mother is / are dependent upon me.
Signature or thumb impression of the subscriber
*Strike out whichever is not applicable
Part B (EPS)
(Part 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.
Sl. Name & Address of the family member Age Relationship with the
No. member
Name Address
1 2 3 4 5
1 SHASHIKALA DOOR NO: 197 55 MOTHER
WARD NO: 8
CHIKKAPETE
SORABA SHIMOGA
2
3
4
* Certified that I have no family as defined in Para 2 (vii) of the Employees’ Pension Scheme, 1971
and should acquire a family hereafter I shall furnish particulars thereon in the above form.
Dated: 12/05/2025 Signature of thumb impression
of the subscriber
*Strike out whichever is not applicable.
Certificate by employer
Certified that the above declaration and nomination has been signed/thumb impressed before me by
Shri/Smt/Km employed in my establishment after he/she has read the
entries. The entries have been read over to him/her by me and got confirmed by him/her.
Signature of the employer or other
Authorised officer of the establishment
Place Designation
Date Name & Address of the Factory /
Establishment or rubber stamp thereof.
Note - Who you can nominate
(A) UNDER THE EMPLOYEES’ PROVIDENT FUND SCHEME :
(1) A member of the Employees’ Provident Fund who is married and/or his father/mother is / are dependent
upon him can nominate only one or more persons belonging to this family as defined below :
(a) In the case of a male member, his wife, his children, his dependent parents and his deceased son’s
widow and children;
(b) In the case of a female member, her husband, her children, her dependent parents, her
husband’s dependent parents, her deceased son’s widow and children.
(2) If the member has got no family, or is a bachelor, nomination may be in favour of any person
or persons, whether related to him or not, or even to an institution. If the member subsequently
acquires a family such nomination shall forthwith become invalid and the member should
make a fresh nomination in favour of one or more persons belonging to his family.
(B) UNDER THE FAMILY PENSION SCHEME :
(1) On the death of a member of the Family Pension Scheme, his family will be entitled to the
benefits under the Family Pension Scheme, The family is defined as under-
(i) Wife in the case of a male member ;
(ii) Husband in the case of a female member; and
(iii) Minor sons and unmarried daughters.
Explanation – The expressions “sons” and daughters” shall include children adopted legally
before death in service.
(2) If the member has got no family, the monthly family pension, on the death of the
member, will not be paid. However, Life Assurance Benefit will be paid to the person or
persons entitled to receive his provident fund accumulations.
EMPLOYEE DECLARATION FORM
Declaration Form for Office Attendance in Hybrid Mode
I, name , GURUPRASAD.B, hereby agree to the following terms regarding my attendance at the office:
I understand and agree that I am required to work from the office every Tuesday and Thursday for all weeks of
the
Month till the continuation of the Hybrid mode until further notice of every day working from the
Bangalore Office.
1. I acknowledge that failure to comply with this requirement may result in the following consequences:
Non-consideration for Office Allowance for any period(s) of non-compliance.
Impact to Appraisal / Performance rating.
2. In case of any exceptional circumstances that may prevent my attendance on the specified days, I have
to notify my Delivery manager and HR department in advance to seek approval.
4. I agree to adhere to the company’s policies and guidelines regarding office attendance and understand
that any repeated non-compliance may lead to disciplinary actions as deemed appropriate by the
Company.
By signing this declaration, I confirm that I understand and accept the above terms and conditions.
Employee Name: GURUPRASAD.B
Employee ID: _____________________________
Department: ENGINEERING
Date: 12/05/2025
Signature:
For Office Use Only:
Manager’s Approval: ___________________________
HR Approval: __________________________________
Company Name
Company Address
Date: _______________
