DEPARTMENT OF ELECTRICAL INSPECTORATE Application Form
Supervisor Grade B Barcode: 0521490
1. Name of applicant ROHITH S 2. Sex Male 3. Date of Birth 16-10-1996 4. Name of Father VN SASI VECHOOR HOUSE KOOVAPPALLY P O, KANJIRAPPALLY KOTTAYAM KERALA 5. Permanent Address 686518, KOOVAPPALLY Pincode. 686518 VECHOOR HOUSE KOOVAPPALLY P O, KANJIRAPPALLY KOTTAYAM KERALA 6. Address for Communication 686518, KOOVAPPALLY Pincode.686518, Mobile: 8075137346 7. Email rohiths673@gmail.com 8. District KOTTAYAM 9. General Qualification Degree B.Tech in Electrical and Electronics 10. Technical Qualification Engineering COLLEGE OF ENGINEERING POONJAR 11. Name and Address of Institution in POONJAR, KOTTAYAM, COCHIN which the candidate has studied for UNIVERSITY OF SCIENCE AND Technical Qualification TECHNOLOGY Chalan Details Amount Chalan Number Chalan Date Name of Treasury District 800 KL009288840201920E 29-10-2019 TRIVANDRAM KOTTAYAM DECLARATION I here by decalre that the particulars stated above are correct to the best of my knowledge, I am not a holder of Supervisor/Wireman Competency Certificate and Permit issued by the Kerala State Electricity Licencing Board other than those indicated in above is agree to the Cancellation of my Permit/Competency Certificate that may issued to me in pursuance of this application in case the particulars furnished in the application are found incorrect or false terminated. Place: KANJIRAPPALLY KOTTAYAM KERALA
686518 Date: 24-02-2019 (Signature) Note: You are requested to print two copies of this application. One copy should be retained by you. The other copy should be duly signed by the applicant and forwarded along with the original chalan of remittance of fee and attested copies of original certificate (to prove the age, technical qualification and experience) to the following address The Secretary, Kerala State Electricity Licensing Board, Department of Electrical Inspectorate, Housing Board Buildings, Shanthi Nagar, Thiruvananthapuram 695 001.