C.I.M.

502

GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
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 ______________________________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 ___________ ____. 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
Name of Mineral..............
.........................................
(Signature of Candidate)
Note:
* Delete if not applicable.

: ________________________________

S.N

Particulars of Practical
experience (a)

Place of
experience (b)

Period of practical
experience ( c)
From

To

Total experience
Years Months Days

Grand Total

AVERAGE MONTHLY OUTPUT (d) AVERAGE DAILY EMPLOYMENT (C) 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 Mines: - _______________________________

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.