Form XXVIII

(See Rule - 53,Rule 54)

Certificate of Stability of a Factory or Part of a Factory

(To be submitted after completion and before working)

I hereby declare that I have personally examined the plans and specifications of the building

described below, the actual materials and methods used in its construction and the finished building

and I am satisfied that its construction is such that its stability will be satisfactory when used as

factory or part of a factory for the purposes herein declared.

1. Name of the factory……………………………………………………….................................….

2. Name of builder (s) or Contractor (s)…………………………………………….................……

3. General type of construction

(a) Full name of signatory (in block letters)…………………………………

(b) Qualifications……………………………………………………………………

(c) Present occupation……………………………………………………………………….

(d) Permanent postal address…………………………………………………………….....

4. Purpose for which the building is to be used………………………………………………………..

5. Name of room or building for which this certificate is granted giving reference to plan no.

6. Nature of work to be carried on in the above room/building………………………………………

7. Nature and amount of moving power………………………………………………

Date……………………………..

Signature of Competent person (Name and Designation)

Signature of occupier (Name and Designation)

NOTE.—The person giving the certificate must be: (a) a Corporate Member of the Institution of Civil

Engineers, or (b) a Corporate Member of the Institution of Structural Engineers or (c) a

Fellow Associate or Licentiate of the Royal Institute of British Architects, or (d) be a

graduate in Civil Engineering and be also a Corporate Member of the Institute of Engineers

(India), provided that no person, except in the case of buildings occupied or erected by any

Government where a certificate may be granted by an officer not below the rank of an

Executive Engineer, shall be authorized to sign a certificate of stability if he is in the full