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    FORM5

    Uploaded by

    Siva Sankar
    The document outlines the form and contents of an Electrical Wireman Grade I permit issued by the Government of Karnataka. The permit contains the holder's name and address, permit number, dates of issue and expiration, examination details, renewal sections, and spaces for endorsements. It allows wiring work but not supervision or electrical contracting. The permit must be carried by the holder, renewed as needed, and returned upon demand.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    FORM5

    Uploaded by

    Siva Sankar
    203 views2 pages
    The document outlines the form and contents of an Electrical Wireman Grade I permit issued by the Government of Karnataka. The permit contains the holder's name and address, permit number, dates of issue and expiration, examination details, renewal sections, and spaces for endorsements. It allows wiring work but not supervision or electrical contracting. The permit must be carried by the holder, renewed as needed, and returned upon demand.

    Original Title

    FORM5(25)

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    © © All Rights Reserved

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    The document outlines the form and contents of an Electrical Wireman Grade I permit issued by the Government of Karnataka. The permit contains the holder's name and address, permit number, dates of issue and expiration, examination details, renewal sections, and spaces for endorsements. It allows wiring work but not supervision or electrical contracting. The permit must be carried by the holder, renewed as needed, and returned upon demand.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    203 views2 pages

    FORM5

    Uploaded by

    Siva Sankar
    The document outlines the form and contents of an Electrical Wireman Grade I permit issued by the Government of Karnataka. The permit contains the holder's name and address, permit number, dates of issue and expiration, examination details, renewal sections, and spaces for endorsements. It allows wiring work but not supervision or electrical contracting. The permit must be carried by the holder, renewed as needed, and returned upon demand.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    80

    80

    FORM – 5
    (Rule – 25)
    Permit in Book Form
    Out Side of Cover

    GOVERNMENT OF KARNATAKA

    ELECTRICAL WIREMAN GRADE I PERMIT

    CHIEF ELECTRICAL INSPECTOR TO GOVT


    AND EX-OFFICIO ADDL. SECRETARY
    (ELECTRICAL LICENSING) DEPARTMENT
    OF ENERGY BANGALORE.

    Inside of cover

    Electrical Wireman Grade I permit No W GR I…


    ……..

    Photo of
    the
    Applicant

    Signature of permit holder

    First page
    Electrical Wireman Grade I permit No W GR I . . . . . . . . . . . . . . . .

    Name and address of the permit holder


    ................................
    ................................

    Second page
    Government of Karnataka
    Electrical Wireman permit No W GR I. . . . . . . . . . . . . . . . . . . . . . . .
    Date of Issue. . . . . . . . . . . . . . . . . . . . . . . .
    Valid up to. . . . . . . . . . . . . . . . . . . . . . . .
    Name . . . . . . . . . . . . . . . . . . . . . . . .
    Date and year of Examination . . . . . . . . . . . . . . . . . . . . . . . .
    Register No. . . . . . . . . . . . . . . . . . . . . . . .
    81
    81

    Details of Exam passed . . . . . . . . . . . . . . . . . . . . . . . .


    Rs . . . . . . . . .. . . . . .paid vide Challan No…
    . . . . . . . . . . .. . .Dated. . . . . . . . . . . . . . . . . . . . . . . .

    CHIEF ELECTRICAL INSPECTOR TO GOVT


    AND EX-OFFICIO ADDL. SECRETARY
    (ELECTRICAL LICENSING) DEPARTMENT
    OF ENERGY BANGALORE.

    Third page
    This permit allows the holder to carry out wiring work only Subject to conditions mentioned in the
    Karnataka (Licensing of Electrical contractors and grant of certificates and permits to electrical
    supervisors and wiremen) Rules 2012 issued by the Government of Karnataka but is does not allow
    him to undertake supervisor and electrical contractors work. This permit is to be carried on the
    holder’s person and is not transferable
    This permit should be got renewed and must be returned to the Licensing advisory Board upon
    demand.

    Fourth Page
    RENEWAL OF PERMIT

    Renewed from. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Valid up to. . . . . . . . . . . . . . . . . . . . .


    Fees Rs. . . . . . . . . . . . . . . . . . .paid vide challan No. . . . . . . . . . . . . . . . . . . . . . . .date. . . . . . . . . . . . .

    CHIEF ELECTRICAL INSPECTOR TO GOVT


    AND EX-OFFICIO ADDL. SECRETARY
    (ELECTRICAL LICENSING) DEPARTMENT
    OF ENERGY BANGALORE.

    Tenth Page

    ENDORSEMENTS OF PERMIT

    Endorsement Licence Date of Date on which Signature Date on which


    Sl Signature of
    made in favour No and expiry of endorsement of the endorsement
    No the officer
    of the firm Class the licence made officer cancelled

    1 2 3 4 5 6 7 8

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