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19th National Certification Examination for Energy Managers And Energy Auditors-September-2018
( Under the Energy Conservation Act, 2001 )
Application Form for Upgradation of Energy Manager Certification to Energy Auditor Certification
Examination you are appearing for  * Energy Auditor
Energy Manager Registration No :*
  EM-
   
1. Caption :*
1a Name of the Applicant*   
2 FatherName*
  3.Present Address*
 
 
 
  City*
  PinCode*
  StateName*
4.Permanent Address
City             
PinCode      
StateName  
5. Date of Birth :*
6. Nationality* (Others Specify)
7. Community*
Note: OBC Non-Creamy layer  refers to Annual Income of less than Rs.8 lakh - eligible for Exam Fee concession
8. Sex*
9. Employment Status*
10 Present Company Address*
  Designation
  Company Name
  Company Address
 
 
  City*
  PinCode*
  StateName*
12.Contact Telephone Fax,Email
Office Phone
Fax
ResPhone
Email*
Mobile
   
       
     
11. Total Work Experience*  Yrs Months
13. Examination appearing *
13a. Examination Centre *      
Written Examination Centre
14. Requisite Educational Qualification *
Slno Name of Degree/ Diploma Subjects/ Branch Year of Passing
(eg: 1988)
Board / University
(Max 50 characters Only)
1.
2.
3.
4.
15. Requisite Experience for fulfilling the eligibility criteria *
Slno Name of Employer/ Organisation Designation
Year
From To
Nature of Work
(Max 50 characters Only)
1.
2.
3.
4.
5.
6.
     
                 
16.   Exam Fee Amount (Rs)      
 

Kindly write legibly your Name and Father's Name in Hindi for issuing Final Certificate in bilingual after taking print out of the application
Declaration by the Candidate
  I hereby declare that all the information given in the application form and enclosures are true to the best of my knowledge. I agree to the condition that if any information or any statement is found to be incorrect, my registration to the examination would be cancelled. 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 and issue 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 examination scheme and conditions as mentioned in the prospectus.  
 
Place
Date