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Form - Ii For Exemption Certificates Under MMR, 1961637140817096804485
Form - Ii For Exemption Certificates Under MMR, 1961637140817096804485
खान अ ध नयम, 1952 / The Mines Act, 1952 हाल का खींचा हुआ अ भ मा णत
(For office use only)
छूट के आधार पर स मता माण प के लए आवेदन प पासपोट साईज फोटो ाफ सामने
Dy.No.
APPLICATION FORM FOR CERTIFICATE OF COMPETENCY (ऊपर) क ओर अ यथ का नाम
Signature
F O R M – II
Application form to be filled in by a candidate for obtaining a 2nd Class Manager’s (R), 2nd
Class Manager’s (UR), Foreman (R), Foreman(UR), Surveyor (R), Surveyor (UR) certificate of
competency on Exemption basis. (Strike out whichever is not applicable)
5. M a ilin g : ………………………………………………………………………………
Address ……………………………………………………………………………….
……………………………………………………………………………….
………………………………………………………Pin…………………...
10. No. & Date of Certificate (s) held under the Mines Act, 1952, if any:
i. 2nd Class Manager’s certificate No : …………...……… dated: ……………………
ii. Surveyor’s certificate No : …………………………...... dated: ……………………..
iii. Foreman’s certificate No : …………………. dated: ……………………..
iv. Mate’s certificate No : ………………………..… dated: ……………………..
v. Blaster’s certificate No : ………………….… dated: ……………………..
11. Training: Period of practical experience* gained in different mines with actual date of
commencement/termination.
Date…………… Signature……………………………
Note:
# ANY APPLICATION WITHOUT THE AFFIDAVIT SHALL BE SUMMARILY REJECTED.
* Experience certificate of Metalliferous mines with average daily employment less than 60 persons (for belowground mine) or 160 persons (for
opencast mine) or 160 persons (In all) shall not be valid. However, In case of opencast mine with less manpower experience may be considered
valid if copy of permission for use of Heavy Earth Moving Machinery granted under Regulation 106 of the Metalliferous Mines Regulations, 1961
is submitted for the experience period.