DIPLOMA PANEL FORM

Application form for empanel the name in the Diploma Engineers Panel list mentioned in the Office of the Chairmen, Committee of Chief Engineers and Concerned Heads of Departments and Engineer-in-Chief (civil), Orissa Nirman soudha, Bhubaneswar. 

1	Name (in Capital Letters)
2	Father’s Name
3	Address (in Capital Letters)	(I)                 Permanent: -         (II)              Present
4	Name of Engineer School
5	Year of Passing Diploma
6	Name of Discipline/Trade
7	Total Mark secured in Diploma Engineers
8	Date of Birth
9	Sex
10	Whether SC/ST/SEBC/General
11	In case if Sportsman/Ex-Serviceman/Physically Handicapped, give details
	DOCUMENTS TO BE PRODUCE
1	Xerox copy of High School Certificate (Matriculation) Duly attested
2	Xerox copy of Diploma certificates duly attested
3	Xerox copy of Diploma Mark sheet duly attested.
4	Xerox copy of certificate in support of physically handicapped/Sports Man/ Ex Service Man

 

            Sri/Smt/Miss………………………………..Son/Daughter of …………………..

do here by under take that the information given are true/correct. In case of any information given proved false, I will be abided to obey the decision to be taken by the Committee in the matter.

 

Date.

Place.                                                                           Signature of the Candidate.