Official :: Vidyut Suraksha Nideshalay

Form-W-B

(See condition no.4 and 6)

Application for grant of wireman permit

1. Name of applicant: .......................................................................................................................................................... (in clear words)

2. Father's Name: ...............................................................................................................................................................

3. Caste: .............................................................................................................................................................................

4. (a) Full postal address: ...................................................................................................................................................

5. Date of Birth: ............................................. ....................................................................................................................

6. Legal and educational qualifications: .............................................................................................................................

7. Treasury invoice number of fees of 210 rupees for application form -...........................date ......................................... Has been paid in the Treasury.

I hereby declare that the details given above are correct. Two photographs with the above mentioned Treasury invoice and confirmation of the details given in column 6 ...........................................................................................................................................................................................................................................................................

In the presence of the following persons:

(1) ........................................

(2) ........................................

........................................

Signature of Applicant

The application is to be signed in the presence of any magistrate or any government official or service adder and the details in it must be given in full swing. If this is not the case then the application will be rejected.

..............................................................................................................................................................................................................................................

Essential : Action will be taken against any such person, who will represenation or assist in doing so for the purpose of obtaining a certificate or permit for himself or another person.