Employee Details - To be furnished by the

employee
Name Deepanshu Singh Kushwaha

Father's Name Sh. S.K Kushwaha

DOB (DD/MM//YYYY) 02/11/1985

DOJ (DD/MM//YYYY) 04/02016

Current Address C-29/B Kotla, Mayur Vihar Phase-1 , New Delhi-91

Permanent Address HOUSE NO -42 Type-4 , SLIET LONGOWAL.SANGRUR 148106

PAN AWGPK004L
Cell Number 9953887942,8400129983
Permanent Contact
Number/Landline
Number 9463334040
Personal Email
Address designer.deepanshu@gmail.com
Emergency Contact -
Name Mr Sumit Kushwaha
Contact Number 9463077009
References
Reference 1 -Name Sumant Arya
Designation Manager Operation Flipkart
Contact Number 9873171061

Employer Address Flipkart Internet Pvt Ltd, Bilaspur(Haryana)

Reference 2 -Name Neha Amrute
Designation Asst. Manager operation
Contact Number 9873141211
 Employer Address Flipkart Internet Pvt Ltd, Bilaspur(Haryana)

Signature of the
Employee

Details required for Mediclaim:

Name Age (In years) Gender

Employee Deepanshu Singh 30 M
Kuswhaha

Father Shri Krishan 61 M

Kushwaha

Spouse N.A

Mother Smt. Kamla Devi 54 F

Children 1 N.A
Children 2 N.A