SELF-DECLARATION

concerning criminal proceedings and private financial circumstances

Name (block capitals): HONNASHREE PREMKUMAR Date of birth: 21/05/1982
Employer COGNIZANT TECHNOLOGY SERVICES
No Police Certificate of Good Conduct having been received I declare as follows
(place cross in box as applicable):
I have been the subject of criminal proceedings1 (criminal conviction, fine or conditional
discharge).
Yes (describe in the Comments field below)
No

Credit information (where reasonable grounds exist for collecting credit information 2):
I do have negative credit remarks (as a consequence of debt collection or debt enforcement
proceedings, including distrainment of earnings), and/or have entered into debt settlements
with creditors.
Yes (describe in the Comments field below)
No

Comments:

The description of comments please send the document by post to:

Norges Bank, Security Department, Personnel Security, Pb. 1179, Sentrum, 0107 Oslo.
The document should be forwarded to: personkontroll@norges-bank.no.

Date: 12/06/2015

Signature: ............................

1 See FOR 2008-01-23 No. 62: Regulation concerning police certificate of good conduct for persons employed by
or rendering services to Norges Bank. (look at the back of the form)2 See FOR-2014-04-24-569 fra 01.07.2014:
Personal Data Regulations, section 4-3.

2
KF SIB (1.1)

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Footnote 1:
Extract from the Regulation concerning police certificate of good conduct that shows which penal
regulation includes:
2. The police certificate content

The certificate shall show whether the candidate is convicted or fined for violation of:
a)The General Civil Penal Code, act of 22 May 1902 No.10
Chapter 8 Felonies against the independence and security of the state 90, 91 and 91a
Chapter 9 Felonies against the constitution of Norway and the head of state 104a
Chapter 11 Felonies against the public service 120, 121, and 122
Chapter 12 Felonies against public authority 127, 128, 132, and 132a
Chapter 13 Felonies against the general order and peace 145, 145a, 145b, and 147
Chapter 14 Felonies against public safety 147a to 150, 151a, 151b, 153, 161 and
162c
Chapter 15 False testimony 163, 165 and 166
Chapter 16 False accusation 168
Chapter 17 Counterfeiting of money 174 to 178
Chapter 18 Forging of documents 182 to 185, 189 and 190
Chapter 21 Felonies against personal liberty 222 to 224 and 227
Chapter 22 Felonies against another person`s life, body and health 228, 229, 231 to 233a,
239, 242 and 243
Chapter 24 Embezzlement, theft and unlawful use 255 to 258
Chapter 25 Extortion and robbery 266, 267 and 269
Chapter 26 Fraud, breach of trust and corruption 270, to 272 and 272 and 275 to 276b
Chapter 27 Felonies in relation to debts 281 to 287
Chapter 28 Vandalism 291 and 292
Chapter 31 Receiving the proceeds of a criminal act 317
Chapter 37 Misdemeanors against public confidence 367 and 369
Chapter 40 Misdemeanors against property rights 391a, and 405a
Act No. 132 of 4 December 1992 relating to medicinal products (Medicinal Products Act)
Act No. 5 of 10 June 1966 relating to customs (Customs Act)
Act No. 1 of 9 June 1961 relating to firearms, ammunition, etc. (Firearms and Ammunition Act)
Act No. 3 of 18 August 1914 relating to defence secrets (Defence Secrets Act)
Act No. 10 of 20 March 1998 relating to protective secret services (Security Act)