State Electricity Board, Uttar Pradesh
                                                      (Hydro-electric unit)
                                                  Visitor permission-form

On this form, which frees the department from liability, there should be signatures of those people who want to see a powerhouse or sub-station, and whenever it is sought, should be given to the officer in charge of the powerhouse.

Date .......................... 196

To,

Powerhouse superintendent
Sub-Station attendant
            In charge of ...............

Please allow the persons mentioned below to visit the powerhouse / sub-station on the date .............. 196.

Signature…………………..

Names and addresses of individuals:
................................................................................
................................................................................

Declaration by the visitors

I / We, the following, hereby declare that I / we fully understand that going within three feet of device installed in the power house is dangerous. I / we am/are about to enter and I / we declare that we are entering the power house/ sub-station at our own risk and that when I / we face any injury while staying in powerhouse / sub-station or nearby, I / We don’t have any right to do claim or proceedings against the department.

..........................................................                  ...............................`.......................
..........................................................                  ......................................................

Signature of the authorized person who will be with the visitors

Time ............................... hours

Date……………………………………..                                                                           Signature ............................................
Designation ............................................