Attendant Secretary

GOVERNMENT OF TAMILNADU

FORM B

(See Rule **)

(First Class Boiler Attendant Certificate of Competency)

(Granted under rule 41 of the Boiler Attendants Rules, 2011)

No.: F-180241 of 2018

having satiofied the Beard of

Shiu S.NALLASIVAM, —_—_ aged about 32 - yearns, at present residing at POTHANUR

Examiners of his competency to fulfill the duties of fist Class Boiler Attendant, is granted under the Boiler Attendants’ Rules, 2011,

this certificate of competency as a First Class Boiler Attendant authorizing him te fave charge of a single boiler with steam pipes of any

type 01 capacity ox two or more boilew with steam pipes in a battery ox separated, the total heating surface of which dees not exceed

1000 square meters, provided that such boikers shall be situated within a radius of 30 meters in the same premises and belong to one owner.

Dated at Chennai this Thirtieth day of January 2019.

te

L. tarry,

Chaifman

. Board of Examiners

Secretary

Board of Examiners ee phot I —— -

‘Description Roll

ae iy *< POTHANUR

/1. Date and Place of Birth 28-06-1986 R

es * 135A, KAMARAJ NAGAR, POTHANUR,

PARAMATHI VELUR TALUK, NAMAKKAL-638181

2. Permanent address

}

ai OF (3. Nationality Indian 4. Height (Without Shoes) 170 cms

a i) A MOLE ON LEFT PALM

{5: ks of identificati r — = si Sarees

P ier ii) A MOLE ON RIGHT SIDE SHOULDER

h. NelAvo~«:

Signature of Applicant

16. Left th

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