GORNMENT OF INDA o 3nso 4O 502

MINISTRY OF C.i.M. 502

LABOjR AND
DIRECTORATE REHABILITATION
GËNERAL OF MINES SAFETY

Certificate of practical
experience granted by the manager to ocandidale for aManager's/Survoyor s/Foremans
granted
/Overman's Sirdar's/Mate's manag
Shotfirer's /Blaster's Certilicale Compelency Examination under the 0a
Mines of E
Regulations, 1957 Metaliferous Mincs
Rogulation, 1961".
. *******°*°*°*'**°*.
. net*m*****des*****ste ****°*"****

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******e**** ***.0

******************* ********************* si *************

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***********************.********.*n.******.o**o* .** ********************"

mjns
K He ku.car. beingthe Menager..RhAYn)alan.I(
that Shri An uMo ML .
Mine Belonging to e X A x e n i hereby certify

whose signature is appended). worked in the

Son of Na>cndla.Maha.
aboveMine frorn.. 201to 25 . ***********
2 and is still working. During his term of
connected with his work
work aforesaid, he has obtained practical experience as detailed over leaf. The duties
have involved his continuous attended at the mine, and have eficiently perfomed 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

aMlaS} kucle en

PO

fcn
h aYa
District

State
ReoSan_

Aru le
 (2)
****

uafu (7) Total Experience

Period of Practical
Place of
Piaclical Expericnce (b) Experience (C
Senal No Partcula of
Fxp:tiencC (3)
Year Month Days
From
oPon casHhonavl6 S-2o1124o1
O6 0 S

acivii

Grand Total
OS

AVERAGE MONTHLY OUTPUT

(d) AVERAGE DAILY EMPLOYMENT (e) DURING THE ABOVE PERIOUDs
GIVEN BELOW:

In below ground
working In open cast working In all

1S

un U MAiMe h
******* ***.************. ****ede***

*****.eana*******saseaeeanka* segae -*aneeaanane****

(Signature of Candidate)
(Signatyre of Manager with date and official
seal s

Instruction
Khaimi 4
(a) State Cleardy the
nature of dulies. Name of Mines
a Pr my
(b) State whether on-surface, in open cast
working or below- ground

(c) State specially the period spent by the applicant in ditterent

f the mining operalons, Of suveying
employment has not been such as to involve
aftendance of the applicant atoperations as the case
how niany wetks and how
many days a week he was
continuous the mine it must be
May be
in what caparity employed at the nine, whether stated
underground above groLnd and
or
 GOVERNMMENT OF INDIA
MINISTRY OF LABOURAND REJIABILITATION
DIRECTORATE GENERAL OF MINES SAFETY

Certificate of practical cxperience granted by the Manager to a candidate for a Manager'

Surveyor's / Overman's / Sirdar's / Mate's / Shotfirer's / Blaster's Certificate of Competen

Examination under the "Coal Mines regulation, 1957 Metaliferous Mines Regulation. 1961"

mohs Manager of
Shri avila p od, being the
I'(SANSSJokine
Ka PuYa Sand Slen do hereby certify
belonging to. 120: 1994
thai Shri A u ny rMehe
(Whose signature is appended).
Son of Shri N a c S h l c Menhdn his tem of work
During
orked in the above mine from 18_ to 2-03*]
connected with his work
a s detailed
overleaf. The duties
aforesaid. he has obiained practical experience
have been efficientiy performed
by him.
continuous attendance at the Mine. and
have involved his

examined for certilicate

to be
character and a fil and proper person
believe him to be of good

of competency.

*****

and ofticial seal)

(Signature with date

me hds
Wai1< P d
Manager:
Mine

P.O

District RUndA
State

YuncALO Moha
(Signature of Candidatc

Sote:
Delete if norapplicable
Sand SJona
 SN Particulars ol practical Place of Period ol practical Toal expeucnce
expericnce (a) Expenence (b) Cxperienee( c)

From Ycaus Monthis Days

e oPom cas4 9nv 318 20-3-19 01 u

mjn
m

Grand Total 01 CD14

AVERAGE MONTHLY OUTPUT (d) AVERAGE DAILY EMPLOYMENT (C) DURING THE ABOVE PERIODS
GIN'EN BELOW:

In open-cast working ; In all

In below-ground working

. p.s.c.aa
date and oflicial seal)
(Signature of the Candidate)
(Signalure of Mandger with

Sand_S3on
Name of
Mines -1KcA Ye

Instriction:

(a) State clearly

the of duties
nalure
in opencast wrorking o r belowground.
b) State rhether on-surface, in dijjerent mining operation.
or surveving
the period spent by he applicant invove continuous
c) State Specially has noi been such as to
a s the case may
be, if the emyloyment and in what
operation the miNC, whether undergroumd or abovegrouud
the applicant at
attendance of
cuypaciu:
a Metalliferous Mine
d) Delete if the mine is
mine is a Coal Mine
(e) Delete if the

Nole whuch is not issued under the official seal of the

Ann certificule of experience oftaining,
concerned AMine manager, would be rejected

Ma Me n n
n