March 1st 2007

Mr. S.S. Dikhale

Vice President - HR
Company XYAZ Ltd.,
Mumbai- 400 013
Ms Sriram. Roopalakshmi (Fictitious name) has joined our organization as Branch
Manager, w.e.f 10th January 2007.
In her personal particulars, she has indicated that she was in your employment as
Projects Sales Manager, from April 2006 to Jan.2007.
We would like to verify her antecedents during her employment in your organization.
For this purpose, I will request you to kindly fill in the attached Antecedent
Verification Form and send the same to me personally by name marked as
Confidential Mail.
I can assure you that the information furnished by you will be treated as Most
Confidential.
At any time in the future, should the need arise and you require similar information, I
will only be too glad to reciprocate.
Look forward to hearing from you soon.
Thanking You,
Sincerely Yours,

Vasant Nair
Vice President Human Resources

JETAIR INDUSTRIES LIMITED

Antecedent Verification Form
(Confidential)
Name :

Fathers Name:

Date of Birth: 29.3.69

Qualifications: B.Com
Employment Details (while in your employment)
Designation: PSM

Period:

From April 06 to Jan.2007

His/her Reporting Relationship:

Salary Details (Please give us break up of his/her Salary)
Basic Pay
House Rent Allowance
Conveyance Allowance
Any Other
Total Monthly Gross
Perquisites:
Provident Fund
ESI ( if applicable)
Gratuity ( if eligible)
Any other like Co.
Car/Driver/Mobile etc.
Incentives ( please mention
average earnings per month)
Total Cost to the Company
Were there any adverse observations in his/her Personal Record while in your
employment?
Yes/No.
If yes, please mention details:

General:
a) How would you rate his/her overall performance while he was in your
employment?
(Please indicate by marking a tick, against the relevant column)
Outstanding
Very Good
Good
Average
Poor

b) His/her state of health? Good/ Very frequently ill.

c) Did he/she formally resign from the services of your Co.?, or
d) Were his/her services terminated?, If Yes, please tell us why?
e) Why did he/she leave your organization?
f)

Would you consider re-employing him/her at any later stage?

g) Any other factual information that you may feel is relevant and would like to
mention:

Signature

Date: