ANNEXURE-XIV (A)

AFFIDAVIT

FOR SCC (MV), (HT) & (EHT)

(To be executed on Stamp Paper, as per the Odisha Stamp Duty Act)

I, ………………………………………………………….aged about …….…….years,

S/O………………………………………………………………………………….resident
of ……………………………………………………………………………..……………is
hereby solemnly affirm and state as follows:-

1. That I am the deponent of this affidavit

2. I have applied SCC (MV) / (HT) / (EHT) on examination / exemption basis to
the SE-cum-Secretary, ELBO.
3. I have declared that all the documents and information furnished by me
regarding qualification, experience, identity proof and conduct certificate are
true & correct.
4. If any of the papers / documents found incorrect / false in future whether
before or after issuance of SCC, my certificate of competency may be
cancelled and legal action as deemed fit may be initiated.
5. That this affidavit is required to be produced before the concerned authority of
Superintending Engineer-cum-Secretary, ELBO, Bhubaneswar for necessary
action.
6. That the facts stated above are true & correct to the best of my knowledge &
belief.

Identified by me Deponent

Advocate

//SWORN BEFORE ME//

Deponent NOTARY, PUBLIC

 ANNEXURE-XIV (B)

AFFIDAVIT

FOR WORKMAN PERMIT

(To be executed on Stamp Paper, as per the Odisha Stamp Duty Act)

I, ………………………………………………………….aged about …….…….years,

S/O………………………………………………………………………………….resident
of ……………………………………………………………………………..……………is
hereby solemnly affirm and state as follows:-

1. That I am the deponent of this affidavit

2. I have applied Workman permit on examination / exemption basis to the
concerned Superintending Engineer-cum-Electrical Inspector.
3. I have declared that all the documents and information furnished by me
regarding qualification, experience, identity proof and conduct certificate are
true & correct.
4. If any of the papers / documents found incorrect / false in future, whether
before or after issuance of Workman permit, my permit may be cancelled and
legal action as deemed fit may be initiated.
5. That this affidavit is required to be produced before the concerned authority of
SE-cum-EI………………. for necessary action.
6. That the facts stated above are true & correct to the best of my knowledge &
belief

Identified by me Deponent

Advocate

//SWORN BEFORE ME//

Deponent NOTARY, PUBLIC

 ANNEXURE-XIV (C-I)

Affidavit by the employee

for the contractor)
AFFIDAVIT

FOR CONTRACTOR LICENSE

(To be executed on Stamp Paper, as per the Odisha Stamp Duty Act)

I, ………………………………………………………….aged about …….…….years,

S/O………………………………………………………………………………….resident
of ……………………………………………………………………………..……………is
hereby solemnly affirm and state as follows:-

1. That I am the deponent of this affidavit.

2. That I have posses valid SCC (MV) / (HT) / (EHT) bearing Certificate
No…………valid upto …………….from SE-cum-Secretary, ELBO,
Bhubaneswar.
3. That I have posses valid workman permit (EHT) / (HT) Lineman (MV) /
Wireman (MV) bearing Permit No………….valid upto ……….from SE-cum-
EI……………….
4. That I am working under………………………………..........................
5. That I have declared that I am not working anywhere else except the above
firm.
6. That this affidavit is required to be produced before the concerned authority of
Superintending Engineer-cum-Secretary, ELBO, Bhubaneswar for necessary
action.
7. That the facts stated above are true & correct to the best of my knowledge &
belief.

Identified by me Deponent

Advocate

//SWORN BEFORE ME//

Deponent NOTARY, PUBLIC

 ANNEXURE-XIV (C-II)

Affidavit by the contractor

AFFIDAVIT
FOR CONTRACTOR LICENSE

(To be executed on Stamp Paper, as per the Odisha Stamp Duty Act)

I, ………………………………………………………….aged about …….…….years,

S/O………………………………………………………………………………….resident
of ……………………………………………………………………………..……………is
hereby solemnly affirm and state as follows:-

1. That I am the deponent of this affidavit

2. That I am the Director / Authorised representative / Managing Director /

Proprietor / Managing Partner / Partner of …………………………..…situated

at…………………………………………………………………………………….…

3. That I / We have appointed & engaged ……………….…(…….) of employees

under my / our firm which are as follows:-

Sl. No. Name SCC / Permit No.

4. That the above named employees are engaged under my / our firm and not
working anywhere else.
5. That this affidavit is required to be produced before the concerned authority of
Superintending Engineer-cum-Secretary, ELBO, Bhubaneswar for obtaining
electrical license (MV / HT / EHT) in my / our favour.
6. That the facts stated above are true & correct to the best of my knowledge and
belief.

Identified by me Deponent

Advocate

//SWORN BEFORE ME//

Deponent NOTARY, PUBLIC