FORM-‘J’(i) (See Clause-34)

HIMACHAL PRADESH STATE LICENSING BOARD

APPLICATION FORM TO GRANT WIREMAN PERMIT BY EXEMPTING FROM APPEARING IN THE EXAMINATION
(To be filled in Hindi/English )

Sr. No. DESCRIPTION (Affix Recent Pass Port

1. Full Name (in Block Letters) : Size Photograph duly
attested by a Gazetted
2. Father’s Name: officer)

3. Date of Birth:
(Authentic proof of age i.e. Matriculation
Certificate issued by the Board of School _______and Age _________
Education)

4. Proof of Indian Nationality:(Any one the following

proof is required to be attached):
(a). Bonafide Certificate OR (b). Ration Card
OR (c. ) Voter ID OR (d.) BPL Certificate
(:Please Specify)

5. Permanent Address: Correspondence Address:

PIN CODE: PIN CODE:

6. Details of Academic Qualification :
(proof be attached)

7 Candidates possessing any of the following

Technical qualification may be exempted from
appearing in Wireman Examination :
(i) Those who are diploma holders in Electrical
Engineering from any recognized Institution
(Be enclosed Self attested Copy):
(ii) Those who have passed any examination of
an institute recognized by the Board for the
purpose(Be enclosed Self attested Copy):

(iii) Deaf and dumb candidates shall be exempted

from taking the oral examination provided
they posses four years experiences in
electrical wiring and other installation under
“A” & “B” Licenses electrical contractor(Be
enclosed Self attested Copy):
8. Two without attested recent copies of
photographs of passport size Name &
parentage on reverse of each photograph(Be
enclosed):
9. Personal marks of identification: (i)

(ii)
10. Three specimen signatures on a plain paper duly
attested by a Gazetted Officer be enclosed:
11. The Exemption fee amounting to Rs.500/- under
correct Head of Account (the Exemption fee Challan No. :-_____________Date_____________
should be accepted through treasury Challan (will
be received after verification of all above Name of the Treasury:______________________
documents).
(Attach the original Challan)
D.D.O. Code No.950 except Capital Treasury
,Shimla-2
D.D.O. Code No.077 Capital Treasury ,Shimla-2
only.
Head of Account:-
0043- Taxes and Duties on Electricity
800- Other Receipts
01-Misc. Receipts.

I hereby declare that the particulars stated above are true and correct to the best of my knowledge.

Dated...............................

Signed by candidate in my presence Signature of Candidate

Dated signature of Gazetted officer Name____________
or Principal of a recognized Institute with Mobile No.____________
address, seal designation& Name .

For office use only:

Sh.…………………………………S/oSh………………………….…………………Vill……………………………….P.O…………………….Teh
…………………Distt…………….State………………………………………. Pin Code…………………… has attended the office of
Secretary Licensing Board, SDA Complex, Shimla-9 on ……………………………. Along with his all required original
certificates/documents. The candidature of the candidate is found fit/unfit to issue the Wireman Permit and
directed the candidate to deposit the requisite fee for the purpose.

……………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………..

Signature of the Candidate: Signature of Dealing Assistant

Signature of Assistant Electrical Inspector Secretary Licensing Board, HP,

Note: Read instructions as given below before submitting the Application form.
1. The application form can be had (free of cost) from the Office of Chief Electrical Inspector, Block No. 29, SDA
Complex, Kasumpti, Shimla-171009.
Or
The applications forms can be downloaded from the website i.e. www.hp.gov.in/elins.
th
2. The candidate must ensure his presence in this office on the 20 day of any month (if this fixed date is holiday the
next working day will be considered for the verification) along with all original documents.
3. Self Attested copies of testimonials be enclosed and submitted alongwith this application form as per check list.
4. The Fee Rs: 500/- will be received after verification of all the documents:
5. . The fee has to be deposited under the given correct Head of Account ( fee deposited through Treasury Challan
only ):-
D.D.O. Code No.950 except Capital Treasury, Shimla-2.
D.D.O. Code No.077 Capital Treasury, Shimla-2 only.
Head of Account:
0043- Taxes and Duties on Electricity
800- Other Receipts
01-Misc. Receipts.
6. Any enquiry contact No. 0177-2621020/2628090.
7. Check List:-Before submitting the Application Form be ensure the following documents as per check list:
 Two un-attested recent passport size photographs showing Name and parentage of the candidate
on its reverse.
 Self Attested copy of Academic and Technical qualification.
 Self Attested copy of proof of Birth Certificate.
 Self Attested copy of proof of Nationality
 One No. registered self addressed envelop of size 25x12cm duly stamped for Rs 37/- to be enclosed.
 The application form complete in all respects be sent to THE CHIEF ELECRICAL INSPECTOR, H
P ELECTRICAL INSPECTORATE, SDA COMPLEX, BLOCK NO. 29 KASUMPTI, SHIMLA (HP)-
171009.