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Experience Certificate

EXPERIENCE CERTIFICATE

Certificate of practical experience granted by the Manager / Agent / Owner to a candidate for
grant of Manager's / Surveyor's / Overman's / Foreman’s / Sirdar's / Mate's / Blaster's
Certificate of Competency under *the Coal Mines Regulations, 2017 / *the Metalliferous Mines
Regulations, 1961.
I, _________________________________________________ being the *Manager/ Agent /
Owner of ___________________________________________________ (‘#’_____________)
Mine belonging to _______________________________________________ do hereby certify that
Shri / Kumari / Smt ______________________________________________ (whose signature is
appended) *Son / Daughter / Wife of Shri ______________________________, worked in the above
mine from ______________ to ______________. During *his/ her term of aforesaid work, *he / she
has obtained practical experience as detailed overleaf. The duties connected with *his/ her work have
involved *his / her continuous attendance at the mine and have been efficiently performed by *him /
her.
I believe *him / her to be of good character, fit and proper person for grant of certificate of
competency.

.......................................................................................................
(Signature of Manager / Agent/ Owner with date and official seal)

Manager’s Certificate Type & No.
(in case of Permit Manager, please provide the authorization letter No. and date)
Name of Mine:
Name of Company / Owner:
Post Office:
District:
State:
Pin:
-------------------------------
(Signature of Candidate)
Note: * Delete whichever is not applicable; # (State Name of Mineral);

 Agent or Owner shall issue the experience certificate to the Mine manager only.
Experience certificates issued to others shall not be valid / accepted.



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16-12-2019    0