Form VII

(For Mines)

(See rule 4(2))

Notice of Commencement/Re-opening/Cessation/Discontinuance/ Abandonment of operations/Closing of mines

I. In case of Notice of commencement the following additional details to be given

Particulars of the Owner/Agent/Manager:

1. Labour Identification Number (LIN), if any

2. Mine Code, if any

3. Details of Owner, Agent, Manager

Sl. Particulars Owner Nominate Agent Manager

No. d

Owner

i. Name

ii. Father’s name

iii. Address Village/area/road– Post

Office- Police Station-

Sub-Division (Taluq)/Tehsil-

Railway station(nearest)- District-

State- PIN-

iv. Mobile Number

v. Telephone number (Landline with STD

Code)

vi. Fax number

vii Email ID

.

4. Date on which it is intended to open the mine (DD/MM/YYYY)

5. Plan(s) to be enclosed as required under Regulations enclosed: Yes/No;

5.1 If yes, specify plans Nos. with date…………………………

6. Safety Management Plan (SMP) enclosed- Yes/No;

6.1 If yes, specify reference number with date…………………………

7. Actual date of opening (DD/MM/YYYY)

II. In case of reopening: following additional details to be given

1. Date on which it is intended to reopen the mine (DD/MM/YYYY)

2. Plan(s) under Regulations enclosed: Yes/No;

2. 1 If yes, specify plan No. with date………

3. Safety Management Plan (SMP) enclosed- Yes/ No

3.1 If yes, specify reference No. with date……

4. Actual date of reopening (DD/MM/YYYY)

III. In case of cessation/abandonment: following additional details to be given

1. Date on which it is intended to close/abandon* the mine (DD/MM/YYYY)

2. Actual date of closure /abandonment* (DD/MM/YYYY)

3. Number of persons likely to be affected

4. Reasons for closure / abandonment *

IV. In case of discontinuance: following additional details to be given

1. Date on which it is intended to discontinue the mine (DD/MM/YYYY)

2. Actual date of discontinuance (DD/MM/YYYY)

3. Number of persons likely to be affected

4. Reasons for discontinuance

5. Updated plans enclosed as required under Regulation - Yes/No

5.1 If Yes, Specify the Plan(s) reference number(s)

V. In case of closing of mines: following additional details to be given:

1. Mine closure plan:

2. Details of protective works to be carried out as per statute:

[Strikeout whichever is not applicable]

Certificate from the Employer

In case of discontinuation/abandonment/cessation/closing of Mines:

I/we hereby certify that the payment of all dues to the workers employed in the establishment has been made and the premises are kept free from storage of

hazardous chemicals and substances.

Yours faithfully

Signature:

Designation: Owner / Agent / Manager

Date:

To

Registering Officer

Inspector-cum-Facilitator

INSTRUCTIONS

* Strikeout whichever is not applicable