SELF-DECLARATION

I, Shri __________________________ Age ___________ presently residing at

_____________________________ state on Solomon declaration that:-
I am associated with the Project as Director/Partner/Project
Manager/Developer/Owner and am authorized to file this declaration. I say that I am made
aware about the provisions of The Building and other Construction Workers (Regulation of
Employment and Condition of Services) Act, 1996 and the Maharashtra Building and
other Construction Rules of 2007.

All the duties responsibilities of the Architects, Project Engineer and Designers related
to the project. I say that I will diligently look after all the safety and health provisions for the
workers under the said Act & will undertake proper maintenance and certification of all
the lifting appliances and gears applied at the site and It will be thoroughly examined
by competent persons. All the workers working directly or indirectly working with the site
will be registered with the Maharashtra Building & Other Construction Workers Welfare board
as beneficiaries.

I say that I will engage only duly qualified and Skilled persons as operators and where
necessary and will abide by the provisions for the runways and ramps used by building
workers also will take due care if workers are asked to do any transportation through water.
I say that I will ensure that all the transport and earth moving Equipment’s used at the
project are properly maintained repaired and are in good state to be used in accordance with
standard safe operation practices and will ensure that the workers use gloves, helmet, hard
hat, safety goggles, proper foot water, masks, fitting clothes at the time of concrete work or
doing any electricity work.

I say that I will appoint responsible person while undertaking excavation or tunneling
work at the construction site and will see that all the warning signs and notices are put up. I
will ensure that all the mandatory provisions of the said act are followed regarding
excavation, pilling and tunnel when this work is undertaken. I say that all the ladders and step
ladders are of good quality, well maintained. I say that all provisions regarding catch
platforms and chutes, structural frame and form work, stacking and unshackling, scaffoldings
cofferdams and caissons are followed at the site. I say that will take due care for following all
the safety provisions as applicable at the site. I will also direct the responsible persons to be
diligent about the safety provisions at site.

Director/Proprietor

Date :
Place: