FORM C

(Government of Mysore Symbol) Government of Mysore Second Class Boiler Attendant Certificate of Competency (Granted under rule 44 of the Mysore Boiler Attendants Rules, 1962) No. of 19 Shri aged about years, at present residing at having satisfied the Board of Examiners appointed under the Mysore Boilers Attendants Rules, 1962, of his competence to fulfil the duties of Second Class Boiler Attendant is granted under the said rules this Certificate of Competency as a Second Class Boiler Attendant authorizing him to have charge of a single boiler of any type the heating surface of which does not exceed, 1,500 feet. He may, however, attend to a battery of boiler (not consisting of more than three connected boiler and not exceeding 1,500 square feet in the aggregate of total heating surface, he is assisted by * Dated at this day of 19

Secretary to the Board of Examiners.

Chairman to the Board of Examiners.

Descriptive Roll:1. 2. 3. 4. 5. 6. 7. Date and place of birth Address Nationality Height without shoes Marks of identification Left thumb impression Signature

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Here insert number of firemen considered necessary by the Chief Inspector.