Regd.Office : Jindal Mansion, 5-A, G. Deshmukh Marg, Mumbai 400 026. Tel. : 496 3000 / Fax : 91-22-496 1400.

APPLICATION FOR EMPLOYMENT

We appreciate your interest in being associated with the Jindal Organisation and wish to give careful consideration to your application. All information given below will be held in strict confidence.

1.

POSITION APPLIED FOR

EDUCATIONAL QUALIFICATIONS

2. NAME Mr. Mrs. Ms. (First Name) (Surname) (Middle Name) 3. CONTACT TELEPHONE NO. 3a. BLOOD GROUP - - select - - A RH +ve A RH -ve B RH +ve B RH -ve O RH +ve O RH -ve AB +ve AB -ve 4.   PRESENT ADDRESS 5.   PERMANENT ADDRESS                   CITY   CITY   STATE - - - - - select - - - - - Andhra Arunachal Pradesh Assam Bihar Delhi Gujarat Goa Haryana Himachal Pradesh Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Tamil Nadu Tripura Uttar Pradesh West Bengal   STATE - - - - - select - - - - - Andhra Arunachal Pradesh Assam Bihar Delhi Gujarat Goa Haryana Himachal Pradesh Jammu & Kashmir Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Punjab Rajasthan Tamil Nadu Tripura Uttar Pradesh West Bengal   TEL.NO.   TEL.NO.   E-MAIL   E-MAIL 4a. HOUSING - - - select - - - With Parents With Relatives Rent Board Own Other IF OTHER SPECIFY 6. DATE OF BIRTH DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 7. AGE YRS 8. PLACE OF BIRTH 9. NATIONALITY 10. PASSPORT NO. 11. DRIVING LICENCE NO. 12. MARITAL STATUS - - - select - - - SINGLE MARRIED SEPERATED WIDOWED 13. FAMILY DETAILS Relation Name(s) Age(s) Education Level Occupation/ Designation Dependant Father Yes No Mother Yes No Spouse Yes No Children Yes No Children Yes No Children Yes No Children Yes No 14. ARE YOU RELATED TO ANYONE WORKING IN THE JINDAL ORGANISATION ? Yes No   (Name) (Designation) (Relationship) 15. NAME AND ADDRESS OF PERSON TO BE CONTACTED IN CASE OF AN EMERGENCY.   NAME RELATIONSHIP   ADDRESS TEL. NO.

EDUCATIONAL QUALIFICATIONS

16. BEGIN WITH HIGHEST QUALIFICATION & STATE ABBREVIATIONS TOO Name of School/ College/Institute (Location) Period Degree/Diploma Obtained Principal Subject (s) Grade/Class / Marks % FROM TO MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 16a. AWARDS/DISTINCTION/RANK/ SCHOLARSHIP RECEIVED 17. IF THERE WERE BREAKS IN YOUR EDUCATION, GIVE DETAILS 18. ANY OTHER CERTIFICATE/PROFESSIONAL COURSE UNDERTAKEN Period Place of Training Stipend/Salary (If any) Nature of Training From To MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 19. LANGUAGE PROFICIENCY Languages (Check your Mother Tongue) Read Speak Write Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight Good Fair Slight

PROFESSIONAL EXPERIENCE

20. Have you worked before Yes No (If Yes then complete the following points or attend point No. 26) Name and Complete Postal Address of Employer Period Position Held Salary (include allowances) Major Activities Undertaken From MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At Start At Start To MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At End At End From MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At Start At Start To MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At End At End From MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At Start At Start To MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At End At End From MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At Start At Start To MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 At End At End 21. IF THERE WERE ANY BREAKS IN YOUR CAREER, GIVE DETAILS   22. PLEASE GIVE DETAILS SHOWING REPORTING RELATIONSHIP IN PRESENT EMPLOYMENT   23. STATE BRIEFLY YOUR PRESENT RESPONSIBILITIES   24. STATE TWO OUTSTANDING ACHIEVEMENTS IN YOUR PRESENT EMPLOYMENT   25. SALARY DETAILS OF PRESENT EMPLOYMENT A) LAST DRAWN EMOLUMENTS MONTHLY ANNUAL BASIC : Rs. GROSS TOTAL : Rs. EDUCATION : Rs. LTA : Rs. HRA : Rs. BONUS : Rs. ANY OTHERS (Specify) P.F. : Rs. a) : Rs. ANY OTHERS (Specify) b) : Rs. a) : Rs. c) : Rs. b) : Rs. d) : Rs. c) : Rs. e) : Rs. d) : Rs. GROSS TOTAL (per month) : Rs. GROSS EMOLUMENTS (per annum) : Rs. B) BENIFITS (i) MEDICAL-DOMICILIARY : SELF Rs. FAMILY Rs.   HOSPITAL : SELF Rs. FAMILY Rs. (ii) LOAN SCHEMES : (iii) ANY OTHER BENIFITS : 26. STATE SALARY EXPECTED (per annum) : Rs. 27. WHEN CAN YOU JOIN IF SELECTED ? 28. ARE YOU A MEMBER OF ANY PROVIDAND FUND ? Yes No   IF YES, STATE YOUR ACCOUNT NO. :

OTHER INFORMATION

29. WHAT ARE YOUR HOBBIES ? 30. WHAT GAMES DO YOU PLAY ? 31. ARE YOU A MEMBER OF A SPORTS CLUB OR AN ASSOCIATION ? Yes No   IF YES, GIVE DETAILS 32. ARE YOU A MEMBER OF ANY PROFESSIONAL BODY ? Yes No   IF YES, GIVE DETAILS 33. ARE YOU IN DEBT ? Yes No   IF YES, GIVE DETAILS 34. HAVE YOU BEEN PROSECUTED IN A CRIMINAL COURT ? Yes No   IF YES, GIVE DETAILS 35. HAS DISCIPLINARY ACTION BEEN TAKEN AGAINST YOU IN ANY PREVIOUS EMPLOYMENT? Yes No   IF YES, GIVE DETAILS 36. ARE YOU WILLING TO BE POSTED ANYWHERE IN INDIA ? Yes No 37. HAVE YOU APPLIED TO THE JINDAL ORGANISATION BEFORE ? Yes No   IF YES, GIVE DETAILS 38. DO YOU HAVE ANY UNUSUAL MARKS OR SCARS Yes No   IF YES, GIVE DETAILS 39. ADDITIONAL INFORMATION IF ANY

REFERENCES

40. LIST REFERENCES WHO HAVE KNOWLEDGE ABOUT YOUR EMPLOYMENT AND PERSONAL INFORMATION FOR THE PAST 4 YEARS. NAME FULL POSTAL ADDRESS TEL . NO. OCCUPATION/ DESIGNATION

DECLARATION

If employed, I agree to abide by and observe all rules and regulation of the Company as prevalent from time to time. I am willing to take medical examination wherever and whenever required. I hereby confirm that the information/ statments given by me in this application form is true. I accept that I shall be liable for dismissal from serviceifnthe same are found to be a misrepresentation of facts at any time during my employment with the company. PLACE : DATE : DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 01 02 03 04 05 06 07 08 09 10 11 12 YYYY 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000