C.I.M.

502

GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND REHABILITATION
DIRECTORATE GENERAL OF MINES SAFETY

Certificate of practical experience granted by the Manager to a candidate for a Manager's / Surveyor's /
Overman's / Sirdar's / Mate's / Shotfirer's / Blaster's Certificate of Competency Examination under the *Coal
Mines regulation,1957 Metalliferous Mines Regulation,1961*.

I, Shri being the Manager of _ _ _

_ Mine belonging to _ do hereby

certify that Shri Son of Shri __

(whose signature is appended), worked in the above mine from _ ___ to _ ___ and is

still working. During his term of work aforesaid, he has obtained practical experience as detailed

overleaf. The duties connected with his work have involved his continuous attendance at the Mine,

and have been efficiently performed by him.

I believe him to be of good character and a fit and proper person to be examined for certificate

of competency.

...........................................................
(Signature with date and official seal)

Manager :
Mine :
P.O. :
District :
State :
.........................................
(Signature of Candidate)

Note:
* Delete if not applicable.
State Name of Mineral-
S.N Particulars of practical Place of Period of practical Total experience
experience (a) Experience (b) experience ( c)
From To Years Months Days

Grand Total

AVERAGE MONTHLY OUTPUT (d) AVERAGE DAILY EMPLOYMENT (e) DURING THE ABOVE PERIODS
GIVEN BELOW:

In below-ground working In open-cast working In all

........................................ ........................................................................
(Signature of the Candidate) (Signature of Manager with date and official seal)

Name of Mine: -

Instruction:-

(a) State clearly the nature of duties.

(b) State whether on-surface, in opencast working or belowground.
(c) State Specially the period spent by the applicant in different mining operation, or surveying
operation as the case may be, if the employment has not been such as to involve continuous
attendance of the applicant at the mine, whether underground or aboveground and in what
capacity.
(d) Delete if the mine is a Metalliferous Mine.
(e) Delete if the mine is a Coal Mine.

Note:
Any certificate of experience of training, which is not issued under the official seal of
the concerned Mine manager, would be rejected.