The Director

Gujarat Energy Development Agency

Udyog Bhavan, 4th Floor, Block No 11-12,

Sector-11,Gandhinagar-382 017.

Tele; 079-23257251-54 Fax: 079-23247097, 23257255

Website: www.geda.org.in E-mail: ec@geda.org.in

Authorization/Renewal of Energy Audit Consultants

PART A: Details of Applicant

1 Name of Organization / Individual

2 Category (Please "✓" mark at appropriate place)
Individual/Proprietary
Public Limited
Research Institution
Partnership
Private Limited
Others (Please Specify)
3 Address (Postal) :

Pin Code :
Telephone/s (with STD code) :
Fax No./ email ID :

4 Name of the Chief Executive :

5 Year of Establishment:
6 Other Professional Membership/s
Chief Electrical Inspector, GoG. Yes / No
PCRA. Yes / No (If “YES” attach proof)
Bureau of Energy Efficiency. Yes / No
Any Other (Please specify) Yes / No

7 Details of Collaboration.
Name of Organization :
Address :

Pincode :
Contact & Designation :

Scope of Collaboration : (In Brief)

8 Details of Support Facilities. (Instruments, lab,
computer, etc.)

Laboratory / Workshop (attach list of equipment).

Instruments (attach list with detailed specification).
Computer
Others (Please specify )
9 Particulars of Expertise/specialty
Audit Type : Thermal , Eletrical , Both.
Type of Industry/ies :
Particular equipment or processes :

PART B : MAN POWER AND EXPERIENCE

1. Table I : Details of Technical Manpower

Sr. Name & Designation Qualification Experience Field Of Whether BEE Certified Auditor
No. (Years) Expertise

(Attach resume of each of the team member with necessary credentials. Use separate sheet)

2. Table II : Projects undertaken during last 3 years.

Sr. Area (*) Sector Sub-Sector No. of Projects

No.

* - Electrical/Thermal/Both (Use separate sheet, if required)

3. List of Major Clients of last 3 years

Sr. Name of Client Contact Person (by Contact Nos. (Telephone)

No. designation)

(Use separate sheet, if required)

PS: Enclose a copy of Energy Audit Study Report prepared by you.

4. Specimen Signature of Certified Energy Auditors

Sr. Name Specimen Signature

No.

PART C: GENERAL INFORMATION

1. List of three references (from industries and govt. institutions)

Sr. Name Address Contact No.

No.
 2. Any additional information in support of your application

3. Details of Payment

DD of Rs.2950/-(2500+18%GST) having DD No. drawn on

Dated

Declaration

The information provided in this form is accurate and true to the best of my knowledge. We agree to the terms &
conditions of Authorization.

 Name & Designation of the authorized signatory :

(Signature) (Seal of Organization)

Date: