AFFIX
PHOTOGRAPH
APPLICATION FOR EMPLOYMENT HERE
POSITIONAPPLIED:
SOURCE:
1. NAME FATHER NAME :Satish Dattaram
SAWANT SATISH VEDANG Sawant
Surname Middle First
2. DATE OF BIRTH (DD/MM/YYYY):13/09/1996 GENDER : Male
SPECIALLY ABLED:NO
BIRTH STATE: Maharashtra BIRTH COUNTRY: India MARITAL STATUS: Unmarried
IDENTIFICATION MARK :Mole on the right
NATIONALITY: Indian BLOOD GROUP: A+ side of the face
3. PRESENT ADDRESS:(Complete address with detailed nearestlandmark, street name) CONTACTNO- +918879163027
EMAIL-
Flat 282,onyx courtyard ,pokharan road no.2, Thane-west Vedang13sawant@
CITY: Thane gmail.com
STATE: Maharashtra
PINCODE:400610
4. PERMANENT ADDRESS (Complete address with detailed nearestlandmark, street name) CONTACTNO- +918879163027
EMAIL-
Vedang13sawant@gmail.com
Flat 282,onyx courtyard ,pokharan road no.2, Thane-west
CITY: Thane
STATE: Maharashtra
PINCODE:400610
5. HAVE YOU BEEN INTERVIEWED BY ICICI LOMBARD OR ANY OF ICICI GROUP COMPANY? IF YES, NAME OF THE COMPANY
OUTCOME:
NA
6. HAVE YOU WORKED WITH ICICI LOMBARD OR ANY OF ICICI GROUP COMPANY IN THE PAST? IF YES, PLEASE PROVIDE DETAILS:
NA
NAME OF THE COMPANY:
TENURE:
EMP ID:
BAND:
DESIGNATION:
7. PLEASE DISCLOSE ANY FITNESS INFORMATION THAT WILL IMPACT YOUR DAY TO DAY SMOOTH DISCHARGING OF DUTIES:
NA
8. HAVE YOU BEEN CRIMINALLY PROSECUTED OR HAVE ANY POLICE OR LEGAL CASE GOING ON CURRENTLY OR HAD IN THE
PAST AGAINST YOU OR FILED BY YOU? PLEASE GIVE DETAILS:
NA
Date: Place: Signature
05 :V
EDUCATIONAL QUALIFICATIONS: (Starting from S.S.C.)
Education Degree/ Year Passed Board/University/Institute Full/ Part Time/ Class/Marks Main Subjects
Certification Correspondence Obtained
10th 2012 ICSE Full 88.14
12th 2014 ICSE Full 85.8 Science -PCM
Bachelor of 2018 Pune University Full 65.66 Electronics and tele communication
engineering-Electronics
and telecommunication
PGDM-Research and 2021 Welingkar Institute of Full 8.2 CGPA Operations-Research and business
business analytics management development analytics
and research
EXPLAIN GAPS/BREAKS IN EDUCATION, IF ANY:
FAMILY DETAILS:
FAMILY MEMBERS NAME OCCUPATION QUALIFICATION AGE
Satish Dattaram Sawant Business Bsc 62
FATHER
Snehal Sawant Banking service B.com 58
MOTHER
SPOUSE
CHILD (With name,
specify if son or
daughter)
CHILD (With name,
specify if son or
daughter)
Date: Place: Signature
05 :V
DETAILSOFWORKEXPERIENCE:
TOTALYEARSOFWORK EXPERINECE – 3 years
Pleaserecordyourexperiencedetailsinchronologicalorder startingfrompresent/lastemployment(Ifyouarecurrentlyworking, please mentionthedurationas
Ex:- 21Oct 2020 totill date):
CURRENT EMPLOYMENT - NAME & ADDRESS OF
COMPANY PERIOD OF STAY HR CONTACT DETAILS
(PH NO. & OFFICIAL
FROM (DD/MM/YYYY): EMAIL ID)
HDFC Bank ,Lower parel
30/06/2021
1 TO (DD/MM/YYYY) /TILL
DATE :24/05/2025
REASON FOR LEAVING: Better Opportunity
LAST DRAWN CTC (p.a):13
EMP CODE:V14606 LPA
DESIGNATION: Manager
LOCATION: Lower Parel, Mumbai
PREVIOUS EMPLOYMENT - NAME & ADDRESS OF
COMPANY PERIOD OF STAY HR CONTACT DETAILS
FROM (DD/MM/YYYY) (PH NO. & OFFICIAL
EMAIL ID)
TO (DD/MM/YYYY)
2
REASON FOR LEAVING: LAST DRAWN CTC (p.a):
EMP CODE:
DESIGNATION:
LOCATION:
SR LAST LAST PLACE OF DATE OF DATE OF REASON FOR
COMPANYNAME
NO DESIGNATION POSTING JOINING SEPARATION LEAVING
Date: Place: Signature
05 :V
GIVE 2 REFERENCES OF IMMEDIATE SUPERVISORS IN CURRENT ORGANIZATION WHOM WE CAN REFER FOR
VERFICATION INDICATING THEIR POSITION AT WORK:
1 Vivek Bhardwaj PH No: 9867712390
OFFICIAL EMAIL ID:
2 Devendra Devrukhar PH No:7498792770
OFFICIAL EMAIL ID :
GIVE 2 REFERENCES OF IMMEDIATE SUPERVISORS IN PREVIOUS ORGANIZATION WHOM WE CAN REFER FOR
VERFICATION INDICATING THEIR POSITION AT WORK:
1 PH No:
OFFICIAL EMAIL ID:
2 PH No:
OFFICIAL EMAIL ID :
PLEASE CONFIRM IF YOU HAVE ANY ACTIVE LICENSE FROM IRDA ASSOCIATED WITH GI/LI COMPANY (AS
AGENT/BROKER/CHANNEL PARTNER ETC.)
1 COMPANY NAME:
Agent/Any other Code:
START DATE: END DATE:
CURRENT STATUS (ACTIVE/INACTIVE):
2 COMPANY NAME:
Agent/Any other Code:
START DATE: END DATE:
CURRENT STATUS (ACTIVE/INACTIVE):
3 COMPANY NAME:
Agent/Any other Code:
START DATE: END DATE:
CURRENT STATUS (ACTIVE/INACTIVE):
PLEASE CONFIRM IF ANY FAMILY MEMBER (INCLUDING RELATIVES) IS CURRENTLY EMPLOYED WITH ICICI LOMBARD OR
ICICI GROUP OR HAS ANY BUSINESS ASSOCIATION (AS AGENT/BROKER/CHANNEL PARTNER ETC.) WITH ICICI GROUP:
1 RELATIONSHIP :
Name:
ICICI Group Company Name : PH No:
Emp ID/Agent/Broker/Any other Code: OFFICIAL EMAIL ID:
2 RELATIONSHIP :
Name:
ICICI Group Company Name : PH No:
Emp ID/Agent/Broker/Any other Code: OFFICIAL EMAIL ID:
3 RELATIONSHIP :
Name:
ICICI Group Company Name : PH No:
Emp ID/Agent/Broker/Any other Code: OFFICIAL EMAIL ID:
First Choice- Thane Second Choice-Mumbai
LOCATION PREFERENCE
English, Hindi, Marathi
LANGUAGES KNOWN
LICENSES AND CERTIFICATES(If Any)
HONORS AND AWARDS(If Any)
JOB TRAININGS (If Any)
Date: Place: Signature
05 :V
DECLARATION
With reference to my application for an appointment in the services of ICICI General Insurance Company Limited
(Company), I hereby declare and undertake the followings:
There is no case pending against me in any Court of Law or in any Police Station. Further, there was no FIR/
Investigation against me in the past and I was never arrested and or convicted in any Court of Law.
If yes, please mention details of such pending case(s) and or reasons leading to such FIR / Investigation / arrest /
conviction in the past including period of detention, if any:
Date: Place: Signature
05 :V
Declaration and Authorization
I hereby authorize ICICI Lombard GIC Ltd (Or a third party agent appointed by the Company) to contact any former
employers as indicated above and carry out all background check not restricted to education and employment deemed
appropriate through this selection procedure. I authorize former employers, agencies, educational institutes etc. to
release any information pertaining to my employment/education and I release them from any liability in doing so.
I confirm that the above information is correct to the best of my knowledge and I understand that any misrepresentation of
information on this application form, in the event of my obtaining employment, may result in action to the extent of my
termination based on Company policy.
Signature:Vedang Satish Sawant
Name:Vedang Satish Sawant
Date:05/31/2024
PAN No:GPXPS5467F
