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

Form 'A' - Application For Certificate Of Competency As Boiler Attendant Class - Ii 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 account of the whole period of my service with out exception, and I make this declaration

conscientiously believing the same to be true.

Date at

this

day of

Signed in the presence of

Signature of the applicant

Present Address:……….………….

……………………………………

Signature:…………………………….

…………...………………………

Designation:………………………….

……………………………………

Note: 1. Every application must be accompanied with original challan for Rs.300/- remitted in any

treasury in Andhra Pradesh State only .

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

Gazatted Officer or the candidate’s employer.

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

renders himself liable to prosecution.

4. Incomplete application is liable to be rejected.

PART – V

(Not to be filled by the applicant)

Certified that Shri ________________________________________________________ has been

examined for Certificate of Competency as Second Class Boiler Attendant and that he has passed /

failed in the examination held during ________________________________



Personal identification mark on Body.

Signature of Board of Examiners

Issue of Certificate of Competency as 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 Class - Ii Page 3