SUBJECT:KELLOGG CONTRACT ISSUE DATE:26/05/2017 NUMBER: TAL-HR-1.

2-FRM
LABOUR MANAGEMENT
SYSTEM - Taloja SUPERSEDES: PAGE:1 of 4

DOCUMENT TYPE:Form REVIEWED: Rev 02

Paste Passport
size
CO N TRACT EM PLO YEE IN FO RM ATIO N SH EET photograph

Date:
N am e ofthe Contractor Scope ofW ork
Designation
N am e ofthe ContractEm ployee
(H elper/Supervisor)
From (Last
Lastem ploym entw ith KIPL (Taloja)details: To (LastDO E)
DO J)

DO B & Age*

ID ProofN o.(Aadhaar /PAN )*

ESIN um ber /W C N um ber*

Bank A/c N um ber & Bank N am e*

UAN (PF)*
M aritalStatus
Q ualification*
(Single /M arried)

PresentAddress

Perm anentAddress

Tel./M obile N um ber

Em ergency ContactN um ber DO J(Ifinterview is

cleared)
O ther
Basic DA H RA TotalG ross
Salary D etails Allow ances

Icertify thatthe inform ation furnished by m e is factually correct,subjectto verification.Iacceptthatan appointm entgiven to
m e on this basis can be revoked and/or term inated atany tim e in future ifany inform ation has been m isstated or unstated.
Place: D ate: Signature of the Applicant:
LeftThum b Im pression RightThum b Im pression

* D ocum ented proofis m andatory to be

provided along w ith this form
 SUBJECT:KELLOGG CONTRACT ISSUE DATE:26/05/2017 NUMBER: TAL-HR-1.2-FRM
LABOUR MANAGEMENT
SYSTEM - Taloja SUPERSEDES: PAGE:2 of 4

DOCUMENT TYPE:Form REVIEWED: Rev 02

Checklist A (For each workman)

Employee Name -
Status
Remarks
SN Checklist (Tick or Responsibility Signature
(If any)
Cross)
1 Hiring eligibility (as per master file
and DOB)
2 Entry into contract workmen
master data base
3 UAN No.
4 ESIC Number
5 Bank account Number
6 ID Proof (PAN/Aadhaar Only) Aparajitha
7 Address Proof (Aadhaar, Ration Representative
Card) (Name)
8 2 Passport size photos
9 Police VerificationAnnual (Letter
of Undertaking by Contractor)
10 Employee Information Sheet
11 All documents verification with
original copies

I hereby confirm that all documents mentioned above have been checked by me and found to be correct
in all respect.

Reviewed By Approved By

Aparajitha Representative For, Kellogg India Pvt Ltd.

Date and Sign Date and Sign
 SUBJECT:KELLOGG CONTRACT ISSUE DATE:26/05/2017 NUMBER: TAL-HR-1.2-FRM
LABOUR MANAGEMENT
SYSTEM - Taloja SUPERSEDES: PAGE:3 of 4

DOCUMENT TYPE:Form REVIEWED: Rev 02

Checklist B (For each workman)

Employee Name -
Status
Remarks
SN Checklist (Tick or Responsibility Signature
(If any)
Cross)
1 Vaccination Status Paramedic
(Name)
2 Medical Examination Status
3 Check for communicable diseases
in last 15 days
4 Medical and Vaccination Health
Card Issued by Health Center
5 Issue of PPE (Safety Shoes and Aparajitha
Goggle) Representative
6 3 pairs of Uniform issued by (Name)
contractor
7 ID Card issue by contractor with all
valid dates, signatures and Stamp
8 Access Control card issued for
plant entry

I hereby confirm that all documents mentioned above have been checked by me and found to be correct
in all respect.

Reviewed By Reviewed By

Aparajitha Representative Paramedic

Date and Sign Date and Sign

Approved By

For, Kellogg India Pvt Ltd.

Date and Sign
 SUBJECT:KELLOGG CONTRACT ISSUE DATE:26/05/2017 NUMBER: TAL-HR-1.2-FRM
LABOUR MANAGEMENT
SYSTEM - Taloja SUPERSEDES: PAGE:4 of 4

DOCUMENT TYPE:Form REVIEWED: Rev 02

FINAL APPROVAL SUMMARY SHEET

Revision- 05(Date of Revision 26/05/17)

Name of the Contractor: ______________________________Date: ________________

Signature of Contract
SN Name of the Workman Workman Remarks
1
2
3
4
5
6
7
8
9
10

HR Document verification: _______________________ _______________

(Checklist A & B) Signature and Name Date

Safety Training:
(EHS Policy & Commitment,
Safety Absolute, _______________________ _______________
Do’s & Don’ts & ERP) Signature and Name Date

Quality Training: _______________________ _______________

(GMP, Allergen & Signature and Name Date
Food Safety)
Final HR Approval: _______________________ ______________
Signature and Name Date

On The Job Training: _______________________ ______________

Signature and Name Date