REFERENCE NO: Pls mention your Emp code here Employment Verification Form Personal Details Photograph (1)

Title (Mr. / Mrs. / Ms.) Name (Last) (First) (Middle) Nationality Date of Birth (yy/mm/dd) Place of Birth US Social Security Number (If applicable) Father s Name Gender: oMale oFemale Marital Status: oMarried oUnmarried Present Residential Address Contact Details Prominent Landmark Exact period of stay at current address (From) (DD/MM/YY) (To) (DD/MM/YY) 1

REFERENCE NO: Pls mention your Emp code here Letter of Authorization To whom it may concern I hereby authorize Wipro Infotech and its representative to verify information provided in my resume and application of employment, and to conduct enquiries as may be necessary, at the company's discretion. I authorize all persons who may have information relevant to this enquiry to disclose it to Wipro Infotech or its representative. I release all persons from liability on account of such disclosu re. Signed : Name in Capitals : Date :