Application Form-Sep 2012

7/29/2019 Application Form-Sep 2012

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App.No: 6623

APPLICATION FORM

13th NATIONAL CERTIFICATION EXAMINATION

FOR ENERGY MANAGERS/ ENERGY AUDITORS-Sep-2012( Under the Energy Conservation Act, 2001 )

Examination you are appearing for: Energy Auditor

Candidature: Self-Sponsored

Signature of the Candidate :

For Office Use Only

Regn. No. _________________________

Remarks if any

___________________________________________________________

Controller of Examination

Affix a recentpassport size photo

Exam Fee Particulars : ( DD should be in favour of "Bureau of Energy Efficiency" payable at'Chennai')

Amount : Rs. 10500 Bank Name,Place : indian overseas bank indirapuram

DD No : 022022 Date : 21/7/2012

1. Name of theApplicant:

BHARAT BHUSHAN SHARMA

2. Father's Name: HARISH KUMAR SHARMA

3. Present Address: 4. Permanent Address

HOUSE NO 126A BRAHMCOLONYNEAR WATER PUMP NO.2

VILLAGE BAROLASECTOR 49 NOIDA

HOUSE NO 126A BRAHM COLONYNEAR WATER PUMP NO.2 VILLAGEBAROLA

SECTOR 49 NOIDA

City: noida City: 201303

PinCode: 201303 PinCode: NOIDA

State: UttarPradesh State: UttarPradesh

5. Date of Birth: 13/12/1988 6. Nationality: Indian

7. Community: General 8. Sex: Male

9. Employment Status: Employed

10. Present Company Address:

Designation: MAINTENANCE ANDINSTALLATION ENGINEER

Company Name: CHEEMA ENGINEERS

PATEL NAGAR SONDA

ROAD MODINAGAR

City: 201204PinCode:

State: UttarPradesh


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11. Total Work Experience: 3Yrs Months

12. Contact Telephone. Fax, Email: Mobile: 9953051587

Office Phone: Fax:

Res. Phone: Email: [email protected]

13.Examination Centre:

a) Written Examination

Centre:1.Delhi/NCR 2. Chandigarh 3. Jaipur

14. Requisite Educational Qualification

SlnoNameofDegree/

Diploma

Subjects/ BranchYear ofPassing

Board / University

1Bachelor of

Engineering

Instrumentation

and control2009 mdu rohtak

15. Requisite Experience for fulfilling the eligibility criteria

SlnoName of Employer/

OrganisationDesignation

Year

From ToNature of Work

1 cheema engineers

MAINTENANCEANDINSTALLATION

ENGINEER

21/7/2009 23/7/2012

Maintenance of panel

used for electrical

design.

Declaration by the Candidate

I hereby declare that all the information given in the application form and enclosures aretrue to the best of my knowledge. I agree to the condition that if any information orany statement is found to be incorrect, my registration to the examination would becancelled. I also understand that it is my responsibility to cross check information from

the websites as mentioned in the prospectus for the allotted examination centre andissue of hall ticket. I shall inform NPC Chennai about any change in my mailing address,

telephone number and e-mail ID, if any, at the earliest. I also abide by the examinationscheme and conditions as mentioned in the prospectus.

Place: noida Signature

Date: 23/7/2012 Name BHARAT BHUSHAN SHARMA

Note:(i) Applicat ion Form received with incomplete particulars will be rejected

(ii) Allotment of Registration Number and Issue of Hall Ticket are subject to receipt of this formduly signed by the applicant along with required documents and Demand Draft on or beforethe last date at the Office of the Director and Controller of Examination, Dr.Ambedkar

Institute of Productivity (NPC), 6, Sidco Industrial Estate, Ambattur, Chennai-600 098

List of Enclosures to be attached with the Application: Please tick

1Proof for requisite educational qualification.(Certificate should beattested by a Gazetted Officer / Employer) *

2 Proof for requisite experience (Excepting the SupplementaryCandidates and candidates applying for up gradation of EMcertificate to EA certificate, who have already submitted the

Experience Certificates). *(Candidates should have acquired the requisite number of

years of work experience as on 31st

July 2012. Candidates will

f


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be registered and guidebooks will be sent only on receipt of

Experience Certificate for which the last date will be 31stJuly

2012. Candidates without requisite work experience are noteligible to register for the examination.)

3 One common DD for Applicat ion fee and Certification fee in favor of

Bureau of Energy Efficiency payable at Chennai. (For supplementarycandidates and candidates applying for up gradation of EMcertificate to EA certificate there is no application fee)*

4 The self-employed candidates should attach proof for atleast twomajor works carried out for the clients. (Attach either work order orletter from the clients). In addition the candidates should attach

photocopies of the Income tax returns for a minimum period of twoyears.*

5 Affix one recent passport size photograph in application form *

6 Proof ofSC/ST/OBC certificates as per Govt. of India format incase of claiming fee concession.Certificates issued in local

languages will not be accepted. *

7 Proof of Income certificate for self sponsored candidates in thecategory of OBC & having annual income not more than Rs. 4.5

Lakh/Annum*

* These enclosures are a MUST for Registration

Documents

Application Form-Sep 2012