D.D.No. Date Value.

GOVERNMENT OF TAMILNADU
THE ELECTRICAL LICENSING BOARD.
Thiru.Vi.Ka.Indl.Estate, Guindy, Chennai-600 032.
FORM"S"
Application for Supervisor Competency Certificate
(Read the instructions overleaf before filling u the form)
1. Name of the applicant
(in block letters)
2. Father's Name
3. Address of the applicant
(in block letters)
4. Date of Birth and age.
(Proof for date of Birth in original along
with xerox copy to be enclosed)
5. Details of Technical Qualification passed
by the applicant.(Certificate in original
alongwith xerox copy to be enclosed)
6. Details of Past and Present experience
(along with evidence.)
7. Have you made any previousapplication?
If so, State reference No. and date.
8. Do you possess Wireman.C.C/Wireman
Helper.C.0 issued by this Board? If so
furnish the Details and surrender the
same.
9. Demand Draft Details.


One photo should be affixed and
attested by the Gazetted Officer.


I hereby declare that the particulars stated above are correct and true to the best of my
knowledge
I request that I may be granted a Supervisor Competency Certificate.
Place : Signature of the applicant.
Date :
Signed before me Gazetted Officer Sign, Designation and Seal.