Scribd
Upload
264 views3 pages

34(6)

This document is an application form for authorization under Regulation 34(6) of the Metalliferous Mines Regulations, 1961, to work as a mine manager. It requires detailed information about the applicant, the mines, and the supervisory staff, as well as supporting documents like medical certificates and Aadhar card copies. The application must be submitted to the Director of Mines Safety in Ghaziabad, along with recent passport-sized photographs.

Uploaded by

RMES Consultancy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
264 views3 pages

34(6)

This document is an application form for authorization under Regulation 34(6) of the Metalliferous Mines Regulations, 1961, to work as a mine manager. It requires detailed information about the applicant, the mines, and the supervisory staff, as well as supporting documents like medical certificates and Aadhar card copies. The application must be submitted to the Director of Mines Safety in Ghaziabad, along with recent passport-sized photographs.

Uploaded by

RMES Consultancy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 3

FORM OF APPLICATION FOR AUTHORISATION UNDER REGULATION

34(6) OF METALLIFEROUS MINES REGULATIONS, 1961


*****
To
:
The Director of Mines Safety,
DGMS Ghaziabad Region Paste here
Room No. 201-203, II-Floor, B- recent passport
Block, CGO-II, Hapur Road,
Kamla Nehru Nagar, Ghazaibad, size
U.P. - 201002. photographs

Sub: Application for permission under Regulation 34(6) of the Metalliferous


Mines Regulations, 1961 to work as manager of mine
Sir,

I beg to apply for manager’s authorization/renewal of authorization under Regulation


34(6) of the Metalliferous Mines Regulations, 1961 to work as Manager of following
mines: (give details of mines, its location etc.)

Detail Mine
s
Name of Mine
ML No./QL No.
Name of Owner as per Lease
document
(Name of all partners in case
of partnership firm)
Survey No.
Village & Post
Taluk/Mandal
District
State & Pin code
Contact No. & email address

Details of Applicant:

1. Name of the Applicant :


1a. Certificate held ( Type, Number &
Date such as Foreman, Second
Class or First Class etc.)
1b Details of last medical
examination (Name of center and
date of medical
examination & validity of
statutory certificate)
2. Father’s Name :

3. Address for correspondence :

4. Contact Number & email address :

Page 1 of
5. Date of Birth :
(Enclose documentary evidence)
6. Aadhar Card Number :
(Enclose copy of Aadhar Card)
7. Were you earlier authorised to act
as Manager under Reg.34(6) of
MMR,
1961, if so
(a) Name of the mine :
(b) Location of the mine :
(c) Name of the owner :
(d) Authorisation Letter No.
& date
(e) Period from & to
8. Number of Shifts worked: :
9. Details of Statutory Supervisory staff (Photo copy of certificate to be enclosed):-
Name
Certificate No. &
Date
Validity upto
9A. Details of Non-Statutory Supervisory staff:-
Name Qualification Experience

10. A. Details of machinery deployed:

SN Machinery Specification HP/ Nos. Total HP


Capacity

11. Details of Mine and owner such as their communication address etc. :

Detail Mine
s
Name of the Mine
i) Name of the Mine:
ii) Mine Code :
iii) Have you filed last
year’s Annual Return
with online “Shram
Suvidha” unified portal
(Return period from
January to December)?
 if Yes, please
indicate submission Id.
:
 if No, reason
thereof :
Name & address of the
owner
Contact number & email
address of owner
No. of leaseholds in the
mine property
(one/two) with validity
of lease
period
Extent of area
No. of workings
(Pits/Sections/Blocks)
Detail Mine
s
Length of the pit
Width of the pit
Depth of the pit
Manpower

deployed/ engaged
Details of Explosive
Magazine such as
licence No. and validity
(enclose a copy of
magazine)
Details of explosives
used at the mine.
Distance between
the mines
Mode of
conveyance
provided to the
manager

I request your goodself to kindly permit me to work as Manager of the above


mentioned mines.

Date:
(Name & Signature of the
Candidate)

Name & Signature of Owner

You might also like