Form XXXVII

[See Rule - 53(3)]

Certificate of Competency issued to a person or an Institution in pursuance of Rule 53 made

under Section2(1)(l).

I,…………………………..in exercise of the powers under Section2(1)(l) of the Code and Rule

made thereunder, hereby recognise.

Shri....................... in the employment of ………………………………(Name of the institution)

or………………………………. (Name of organisation) as a competent person for the purpose of

carrying out tests, examinations and inspections and certification of such building, dangerous

machinery, lift and hoists, lifting machine and lifting tackles, pressure plants, confined space,

ventilation system and such other process or plant and equipment as the case may be, used in

factory located in…………………………. under Section ........................................... and the rule made

thereunder.

This certificate is valid from………….. to.........................

This certificate is subject to the following conditions namely :-

(i) tests, examination and inspections shall be carried out in accordance with the provision

of the Code and the Rule made thereunder;

(ii) tests, examination and inspections shall be carried out under direct supervision of the

competent person or by a person so authorized by an institution recognized to the

competent person;

(iii) the certificate of competency issued in favour of a person shall stand cancelled if the

person leaves the organization mentioned in his application;

(iv) the institution recognized as a competent person shall keep the Chief Inspector cum

Facilitator informed of the names, designations and qualifications of the persons

authorized by it to carry out tests, examinations and inspections.

Place :

Signature of the Chief Inspector-cum-Facilitator

Official Seal

Date :

Note.—A separate certificate should be issued under each relevant Section. A person or an institution

may be recognized as a competent person for the purposes of more than one Section of the

Code.