FORMAT OF EMPLOYMENT CERTIFICATE

Name of the Organization: ______________________________________________

Address ______________________________________

_______________________________________

_______________________________________

_______________________________________

Pincode : ________________ Telephone No.________________

Fax No. ______________________

This is to certify Shri _____________________________________ is/was employed in our

organization as ________________________________ in the fields related to boilers as
specified below:

S.No. Field related to boilers From To

1 Design
2 Manufacture
3 Commissioning
4 Operation & Maintenance*
5 Inspection & Certification during manufacturing or
operation & maintenance (strike whichever is not
applicable)
6 High pressure welding

* The Experience in the operation and maintenance of boilers was during the period
________________ to ________________ and the details of boiler are as under:

Boiler Registration No. :

Type of Boiler :
Heating Surface Area :
Working Pressure :

The above information is furnished are as per our records.

Signature Countersigned by:

Name of the authorised Official: Name of the Official:

Designation with office Seal: Designation with office seal

Date: Date:
(use additional sheets if required)