FORM - A GOVERNMENT OF ANDHRA PRADESH ANDHRA PRADESH ELECTRICAL LICENSING BOARD APPLICATION FOR EXEMPTION FROM THE EXAMINATION

FOR ELECTRICAL SUPERVISOR (Utilisation / Mining)

(To be filled in English or Telugu)

Photo attested by Gazetted Officer

Surname 1. Full Name of the applicant (In block letters) 2. Fathers Name 3. Date of Birth and Age 4. Present Address :

Name

: : :

5. Permanent Address

6. (i) Details of Technical Qualification (ii)General Education Qualifications

: :

7. Details of past and present service (Date of commencement And termination) with brief description of each to be given To enable assessment of experience in Electrical Works (in separate sheet). 8. Details of present status of employment 9. Supervisor/Wireman Permit No. Voltage level: (Xerox copy of book shall be enclosed) 10. Amount of fee remitted: (i) Challan No. (ii)Date: : Date of Issue:

(iii) Treasury

(iv) Amount Rs:

: 2: 11. Marks of identification of the Applicant 1. 2. 12. Four specimen signature of applicant. (In a separate sheet)

13. The following are to be enclosed with this form: (a) Attested Xerox copies of Education, SSC and Technical Qualifications. (b) Certificates of Latest character and conduct Certificate issued by Gazetted officer. (c) Experience in Electrical installation: Works in detail Specifying voltage levels. (d) Treasury Original Challan for Rs.350/-: paid to the following Head of Account: Major Head: 0043 Taxes and Duties on Electricity Minor Head: 102 Fees under Indian Electrical Rules DDO Codes: 25000502001 Secretary, A.P.E.L. Board, Mint Compound, Hyderabad (e) Four Copies of latest pass port Size photographs. (f) Power Medicine & First Aid Certificate. Obtained from St.jhon Ambulance Association, Sultan Bazar, Hyderabad (Original + Xerox copy) (g) Stamped self address cover Rs.40/(h) 4 Specimen signatures on white paper. (i) Proof of address. (j) Identity proof.
I hereby declare that particulars started above are correct and true to the best of my knowledge and

belief.

Signature of applicant

Signature of the Present Employer (With seal) Not less than Managing Director/Director/ General Manager/Plant Manager)