wo AERTS, AAT TATA HATETTOT WIT UIE-a, AAMT %, RoRe/AHT eB, MH ITE FORM-B1 (See rule 15) Recent passport size color photograph Signature Application form for exemption from Electrical Wireman examination (TO BE FILLED (TYPED) IN MARATHI/ENGLISH/HIND]) T | Fullname and address of applicant (Mobile no. and Email ID) 2 | Date of Birth and age (Gubmit self attested copy of school leaving certificate) 3 | Qualification (Submit self attested copies of certificates) period a 5_| Training place and name of Institute 6 | Fees as prescribed in Rule 45 Fee for exemption from Wireman examination 7. | National Trade Certificate Course passed from which state Declaration for exemption of Electrical Wireman Permit in Maharashtra State, Thereby declare that I am not holding any wireman permit issued by Maharashtra State or any other State. If found so, I am liable for prosecution for false information. Son / Daughter of-——- sident of. -—--—- hereby declare that the copies attested by me are true copies of original documents. I am well aware of the fact that if the copies are found to be false, I shall be liable for prosecution and punishment under Indian Penal Code and / or any other law applicable thereto, Place : Dat Note :- 1. Submit self attested copies of all certificates. 2, Self attested copies of Photo Identity (Passporv/PAN card/Aadhar card) 3. Two Copies of the latest passport size color photograph of the applicant to accompany the application with name on the back. 4. Any person making false statements for the purpose of exemption from electric wireman examination shall render himself liable for prosecution, 5. Details of past and present service (Date of Commencement and termination of each appointment to be given) testimonials, original and copies thereof, to be submitted, 6. Incomplete application will be rejected. Applicant signature