1 Date of Experience Certificate

2 Name of the Employee MURUGANANDHAM.A

3 Father's Name of Employee AYYAPPAN.A

4 Date of Birth of Employee 7-Jun-84

5 Qualification of Employee BE(EEE)

6 Month and Year of Passing of above Qualification Nov-05

7 Name and Address of the Firm/Company RELIANCE JIO INFOCOMM LTD

8 Date of Joining in the Firm / Company

Qualification possessed by the Employee on the Date of Joining Service in

9 the Firm/ Company

10 Whether the said Firm/ Company is a recignized one?

If yes, Registration Number/ Particulars of Firm/ Company if

any(EA/ESA/GST Eetc.,)

11 Designation of Employee ASSISTANT MANAGER

12 Period of Experience of the Employee From …..To…….

13 Name and Address of the Site 135/1, UPPILIPALAYAM ROAD,

SOWRIPALAYAM, COIMBATORE-641028

Is, Still in service in this site / Left In Service

If left, Date of releving NOT APPILICABLE

14 Name of the R3 person of the Site & his/ her SCC No:………. With Validity

15 Site HT Service No and date of energization HT SC.No:223

Rating of the Incomming supply Voltage( 11/22/33/110/230/400KV)
Sanctioned Demand

16 Power rating of EHV/HV equipments ( Transformer, Generator, Moto Transformer-500KVA, Generator- 2 X 625KVA
etc., )

17 Nature of the Work/Duty performed by the Employee including High Yes / No

Voltage system ( To be mentioned in Brief) ( If required attach seperatly)

Whether Attendence Register / Attendence Rolls/ Pay Register and other

records available for this employee?Whether Electrical Inspector
18 Certificate for the appilicant presence during R-30/R-43 inspection Yes / No
enclosed?

Certified that the above particular's are true and as per the records available and to the best of my knowledge

Date Signature
Place Name & Designation of the issuing Authority
Office Seal