Tcs Annexure

11/17/2010 tcs annexure
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scribd.com/doc/…/tcs-annexure 1/18
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Ilp Month Joining TCS Surety Verification Documents Ilp Center
Service Agreement TCS Annexure TCS Recrutment
IN WITNESS WHEREOF, I have put my signature on this undertaking on this …………day of ………… …….,
2009.
Signature of the Candidate: _____________________________________
Name of the Candidate: ______________________________________
TCS Offer Reference No : ______________________________________
Place: ______________________________________
Date: ______________________________________
1. Witness:
Signature of the Witness: _____________________________________
Name: _____________________________________
Address: _____________________________________
_____________________________________
Place: _____________________________________
Date: _____________________________________
2. Witness:
Signature of the Witness: _____________________________________
Name: _____________________________________
Address: _____________________________________
_____________________________________
Place: _____________________________________
Date: _____________________________________
TCS Confidential Page | 14
Please hand over the completed form to your Induction Coordinator
Medical Certificate of Fitness
Section 1: Candidate’s Personal Details
Please fill in the complete from and sign it. Please affix a
Passport size
Mr./Mrs./Ms./Miss/Dr First Name: ______________________ Last Name: __ __ __ __ __ __ __ __ __photo
__ _here and
get it attested by
Gender: Male Female Date of birth (DD/MM/YY) ___/___/___ your consulting
doctor
Contact No: (M) __________________ (R) ____________________ Blood Group: ____ __
Candidate Statement
Do you have any congenital defect / abnormality? Yes No. If yes, please provide the details
______________________________________________________________________________________________________
Do you have any physical deformity / handicap or use any mechanical / physical assistance for mobility? Yes No. If yes,
please provide the details
______________________________________________________________________________________________________
Have you had any form of serious illness or operation in the last two years? Yes No. If yes, please provide the date and
details of the surgery
______________________________________________________________________________________________________
Have you been treated or hospitalized for cancer, Tumor, Cyst or any other growth? Yes No. If yes, please provide the
details
______________________________________________________________________________________________________
Has medical grounds been a reason for un-employment or you not performing a specific role in the past? Yes No. If yes,
______________________________________________________________________________________________________
Have you ever suffered or suffering from any of the following?
High Blood Pressure Stroke Bronchitis Obesity Diabetes Arthritis
Blood Spitting Peptic Ulcer Drug abuse Heart Disease Skin Infection Bowels
Heart Murmur Tuberculosis Epilepsy Thyroid Ailment Arthritis Asthma
Heart attack Slipped disc Liver disease
Have you ever suffered or suffering from any other illness or impairment not mentioned above? Yes No. If yes, please
provide the details
Are you presently in a medical condition that may require you to be away from work in the next 12 months? Yes No. If yes,
______________________________________________________________________________________________________
Declaration
I declare that to the best of my knowledge, the answers to the questions in this form are correct and that I am not suffering
from any disease/illness, the presence of which I have not revealed. I fully understand that any misrepresentation of this
declaration could lead to the termination of my offer/appointment. I have no objection to Tata Consultancy Services Pvt. Ltd.
seeking further information either directly from me or from my Consulting doctor or other appropriate doctor. In case of any
discrepancy arising out of my declaration, I will be undergoing the medical check-up by the Company’s suggested medical
clinic/doctor and their findings will be fully binding on me and any action thereon towards my employment will be accepted
by me.
Signed: ______________ Date: (DD/MM/YY) ___/___/___
/ 16
Section 3 - The Candidate needs to ensure that a legally qualified and registered medical practitioner with minimum qualification
as M.B.B.S. completes this form. Additional sheets may be attached if more space is required.
Note: The candidate is responsible for any costs associated with the preparation of this report.
or Free
Section 3: Medical Practitioner’s details
Full name (as listed on applicable state registry) ______________________________________________________
Registration ID: ____________________________
Postal Address: _________________________________________________________________________________
Contact No: (Day time) ______________________
Section 4: General Examination
Body wt: ______ kgs; Pulse: ______ /min; BP: ___________mm Hg; Height: ______ cms;
Declaration
I, certify that I have carefully examined Mr./Mrs./Ms./Miss/Dr __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ son/daughter of Mr.

___________________________________________________.
He/she is medically fit/unfit for employment with TCS.
Remarks: ________________________________________________________________________________________
Signed: ______________ Date: (DD/MM/YY) ___/___/___
& Sealed
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11/17/2010 tcs annexure

Signature of the Candidate: _____________________________________

Name of the Candidate: ______________________________________

TCS Offer Reference No : ______________________________________

Signature of the Witness: _____________________________________

Signature of the Witness: _____________________________________

TCS Confidential Page | 14

Please hand over the completed form to your Induction Coordinator

Medical Certificate of Fitness

Have you ever suffered or suffering from any of the following?

High Blood Pressure Stroke Bronchitis Obesity Diabetes Arthritis

Heart Murmur Tuberculosis Epilepsy Thyroid Ailment Arthritis Asthma

Heart attack Slipped disc Liver disease

TCS Confidential Page | 15

Section 3: Medical Practitioner’s details

Full name (as listed on applicable state registry) ______________________________________________________

Registration ID: ____________________________

Postal Address: _________________________________________________________________________________

Section 4: General Examination

I, certify that I have carefully examined Mr./Mrs./Ms./Miss/Dr __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ son/daughter of Mr.

He/she is medically fit/unfit for employment with TCS.

Signed: ______________ Date: (DD/MM/YY) ___/___/___

TCS Confidential Page | 16

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I, certify that I have carefully examined Mr./Mrs./Ms./Miss/Dr son/daughter of Mr.

Signed: ____________ Date: (DD/MM/YY) _/_/_