Form 'A' - Application For Certificate Of Competency As Boiler Attendant Class - Ii
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6FORM ‘A’
[See rules 26 and 42 of the Boiler Attendants’ Rules – 2011]
Application for certificate of competency as Boiler Attendant Class – II
PART – I
Name etc of the applicant
1.
Name (in full)
Father’s Name
2.
3.
Nationality
Photo
4.
Date of Birth
5.
Place of Birth
6.
Permanent Address
7.
Email Address
8.
Cell Phone No.
9.
Whether appeared in any
previous examination
10. If so, details of place and
date
11. Challan No……………….….…..., Date ……...……………….. Amount Rs. 300/-
place of STO / SBH / SBI ………………………….……….
PART – II
PARTICULARS OF ALL CERTIFICATES SUBMITTED
Number of
Class of
Place of
Date of
If at any time
Date of
Reasons of
the
Certificate
issue
issue
Suspended or
suspension
suspension
Certificate
cancelled, and if
or
or
so state by whom
cancellation
cancellation
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