The document is an application form for a Supervisor Competency Certificate from the Electrical Licensing Board of Tamilnadu, which requires applicants to provide personal details like name, address, date of birth and qualifications, along with experience details, payment details, photos and signatures to be attested by a gazetted officer in order to be considered for the certificate. Instructions are also provided specifying the application fee of Rs. 750, acceptable qualifications and experience required, and documentation to be submitted like photos, signatures and evidence of age.

1. GOVERNMENT OF TAMILNADU
THE ELECTRICAL LICENSING BOARD.
Thiru.Vi.Ka.Indl.Estate, Guindy, Chennai-600 032.
FORM"S"
Application for Supervisor Competency Certificate
(Read the instructions overleaf before filling u the form)
1. Name of the applicant
(in block letters)
2. Father's Name
3. Address of the applicant
(in block letters)
4. Date of Birth and age .
(Proof for date of Birth in original along
with xerox copy to be enclosed)
5. Details of Technical Qualification passed
by the applicant.(Certificate in original
alongwith xerox copy to be enclosed)
6. Details of Past and Present experience
(along with evidence.)
7. Have you made any previousapplication?
If so, State reference No. and date.
8. Do you possess Wireman.C.C/Wireman
Helper.C.C issued by this Board? If so
furnish the Details and surrender the
same.
9. Demand Draft Details.
D.D.No. Date Value.
One photo should be affixed and
attested by the Gazetted Officer.
I hereby declare that the particulars stated above are correct and true to the best of my
knowledge
I request that I may be granted a Supervisor Competency Certificate.
Place : Signature of the applicant.
Date :
Signed before me Gazetted Officer Sign, Designation and Seal.

2. INSTRUCTIONS:-
1. Issue Fees for Supervisor Competency Certificate = Rs.750/-.
From 01.01.2011 onwards.
(ii) The fee should be paid by means of Demand Draft obtained from any scheduled Bank or
Co-operative Bank drawn in favour of the Secretary, Electrical Licensing Board,
Chennai – 600 032. Payable at Chennai. Remittance by any other method will not be
accepted.
2. The signature of the applicant and the photo to be affixed in the application should be
got attested by a Gazetted Officer. Out of three photos mentioned under item (4) of the
instructions one photo should be affixed in the space provided in the application and the
same should be attested by a Gazetted Officer.
3. The applicant should be a Diploma holder in Electrical Engineering obtained from the
Department of Technical Education or a Degree holder in Electrical Engineering issued
by any University in India or A.M.I.E. Certificate in Electrical Engineering with Part A
& B.
(with)
Experience :- Two years experience in erection or operation and maintenance
in High Voltage installation.
(or)
The applicant should be an Electrical Supervisor Competency Certificate obtained from
the Department of Technical Education. Chennai.
4. Three copies of Passport size photograph of the applicant (6cm x 4 cm) (taken not
earlier than three months from the date of application) should be sent.
5. Applicaant's signature in triplicate on a separate sheet of paper should be sent.
6. Evidence for age in original and zerox copy should be furnished.
7. All the columns should be answered in words and figures and no columns should be left
blank.
8. Application should be only in the prescribed form .