Form 'A' - Application For Certificate Of Competency As Boiler Attendant (Page 3 of 3) in pdf

Form 'A' - Application For Certificate Of Competency As Boiler Attendant Page 3

PART IV: DECLARATION TO BE MADE BY THE APPLICANT

I do hereby declare that the statements made in Part I, II and III of this form are correct and true to the

best of my knowledge and belief; and that the papers enumerated in Part II and submitted with this

form are true and genuine documents and further that the copies of the documents submitted with this

form are true and correct. I further declare that the statements made in Part III contain a true and

correct amount of the whole period of my service without exception, and I make this declaration

conscientiously believing the same to be true.

Dated at ……………..this day of …………………..20….

Signature of the applicant

Present address.

Signed in the presence of

Signature…………………

Designation ………………

NOTE:

1. Every application must be accompanied with the requisite fee in the manner as may be prescribed

by the Government.

2. Two copies of a recent bust photograph of the applicant (size 50mm X 65mm) must accompany the

application with applicant’s signature on the back thereof, duly attested by a Gazetted Officer or

the candidate’s employer.

3. Any person making a false statement for the purpose of admission to the examination renders

himself liable to prosecution.

4. Incomplete application is liable to be rejected.

PATR V

( Not to be filled by the applicant)

Certified that shri ………………………………..has been examined for Certificate of Competency as

First / Second Class Boiler Attendant and that he has passed/failed in the examination held

during………………….

Issue of Certificate of Competency as First / Second Class Boiler Attendant when certified to have

passed………

Certificate No………….issued on………………and duplicate recorded.

(Secretary)

Board of Examiners

Form 'A' - Application For Certificate Of Competency As Boiler Attendant Page 3