Examination you are appearing for * Energy Manager Energy Auditor

Candidature:* Company Sponsored Self-sponsored

1. Caption :* Mr Mrs Miss
1a Name of the Applicant* PANKAJ Middle Name POTDAR
2 FatherName* ASHIK KUMAR POTDAR
3.Present Address*
1-5-3/2B
V. V. NAGAR STREET NO 08
HABSIGUDA
City* HYDERABAD
PinCode* 500007
StateName* Andhra Pradesh
4.Permanent Address
1-5-3/2B
V. V. NAGAR STREET NO 08
HABSIGUDA
City HYDERABAD
PinCode 500007
StateName Andhra Pradesh
5. Date of Brith :* 14/03/1975
6. Nationality*

Indian (Others Specify)
7. Community* General SC ST OBC
8. Sex* Male Female
9.
Employment
Status*
Employed Self Employed Unemployed
9a. If Employed* Govt Private Public Sector Others
10 Present Company Address*
Designation MANAGER - EHS
Company Name LARSEN & TOUBRO LTD
Company
Address
UPPAL PRECAST YARD
OPPOSITE TO TOYOTA SHOWROOM
SHANTHI NAGAR UPPAL
City* HYDERABAD
PinCode* 500039
StateName* Andhra Pradesh
12.Contact Telephone Fax,Email
Office Phone 64650192
Fax
ResPhone
Email* potdar@lntecc.com
Mobile 9000081055
11. Total Work Experience 16 Yrs Months
13. Examination Centre
Written Examination Centre Hyderabad Mumbai Chennai
14. Requisite Educational Qualification*
15th National Certification Examination for Energy Managers And Energy Auditors-August-2014
( Under the Energy Conservation Act, 2001 )
Application Form
Page 1of 2 ::Application Entry::
08-04-2014 http://admin.aipnpc.org/StuApplication.aspx
Slno Name of Degree/ Diploma Subjects/ Branch Year of Passing
(eg: 1988)
Board / University
(Max 50 characters Only)
1. MASTER OF TECHNOLOG ENVIRONMENT MANAGEME 2006 Rajiv Gandhi Proudyogiki Vishwav
2. B. E. (PART TIME) MECHANICAL 2004 Rajiv Gandhi Proudyogiki Vishwav
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. Larsen & Toubro ECC MANAGER-EHS 16/02/2012 08/04/2014 Planning, organizing, mon
2. Hindustan Construction Co MANAGER-HSE 25/07/2011 01/02/2012 Responsibilities include o
3. Galfar Engineering & Contr EHS-MANAGER 01/08/2009 24/07/2011 Preparing risk assessmen
4. Leighton Oriental (J V) ENVIRONMENT OFFICER 10/02/2006 30/07/2009
5. Kirloskar Brothers Ltd. EHS Officer 01/11/2000 31/12/2005
6. Steel Tubes of India Ltd Mechanical maintenance sup 01/12/1997 31/10/2000
16 DD No Amount(Rs) Bank Name
Place HYDERABAD
Date 07/04/2014
DD date
Kindly write legibly your Name and Father's Name in Hindi for issuing Final Certificate in bilingual after taking
print out of the application
* I permit BEE/NPC to part with my personal information given in this application for use by
a) Concerned parties (BEE,NPC and other Government agencies) Yes No
b) Anyone who seeks personal contact data under RTI Yes No
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.
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Page 2of 2 ::Application Entry::
08-04-2014 http://admin.aipnpc.org/StuApplication.aspx