Head Office: Dudhwala House, 292, Bellasis Road, Mumbai Central, Mumbai - 400008

PERSONAL DATA FORM

Affix your recent

photograph

Name: _______________________________________________________________
First Middle Last

Designation: ____________________________ Date of Joining: _______________

Location: ____________________________________________________________

Company: ____________________________________________________________

NB: This form is a property of Dudhwala Group. No part of it may be circulated, quoted
or reproduced without written approval from Dudhwala Group.
1. PERSONAL DETAILS

Name Father’s Name Surname

Age: ___ yrs ___ months Gender: M / F Marital Status: Married / Unmarried
Date of Birth: __________________ Place of Birth: _______________________
Religion: ______________________ Nationality: _________________________
Present Address: _____________________________________________________
___________________________________________________________________
Tel. No.: _____________________ Mobile No.: ___________________________

Permanent Address: __________________________________________________

___________________________________________________________________
Tel. No.: _____________________ Mobile No.: ___________________________
Email id.: ___________________________________________________________
Residential Status: own house / rented house / with parents / with relatives
Passport Details:
Passport No.: _______________________ Date of Issue: ____________________
Place of Issue: ______________________ Valid Upto: ______________________
PAN No.: _____________________ Driving Licence No.: ____________________

2. HEALTH DETAILS
Height: ____ ft ____ inches Weight: _____ kgs Colour of eyes: __________
Colour of hair: _____________________ Blood Group: _____________________
Special Identification Mark (if any): ______________________________________
Prolonged Disability / Illness (if any): _____________________________________
Current Medication: ___________________________________________________
Physician’s Contact No. ________________________________________________

3. LANGUAGES KNOWN
(Start with your mother tongue)
Language Read Write Speak
4. EDUCATIONAL QUALIFICATION
(Start with the highest qualification)

Examination Year of Marks

Institute
Passing (%)

5. SPECIALIZED TRAINING, OTHER QUALIFICATION, ETC.

(Diploma Courses, Certificte Courses, Other Short-Term Courses)

Name and Location Qualification Obtained Year Course Details

of Institute

6. FAMILY DETAILS

Name Relationship DOB/Age Occupation Address

7. EMPLOYMENT HISTORY
Total work experience: ______ years ______ months
Details of previous employment

Name & Address of Date of Date of Salary Reason for

Designation
Previous Employer Joining Leaving Drawn Change

8. OTHER PARTICULARS
Do you have any relative / friend employed with us?
If yes, please give details.
Have you been referred by any of our employee?
If yes, please give details.
Have you ever been arrested or convicted in
criminal proceedings or fined?
If yes, please give details

9. EMERGENCY CONTACT DETAILS

Name: ____________________________________________________________

Address: __________________________________________________________

__________________________________________________________________

Contact No.: _______________________________________________________

I certify that the statements made by me are true, complete and correct to the
best of my knowledge and belief. I understand that any misrepresentation or
omission above renders me liable for termination / dismissal from service without
notice.
Date:
Place: Signature