Form of Certificate of Stability

1. Name of the factory:

2. Village, town and district in which the factory is situated:

3. Full postal address of the factory:

4. Name of the occupier of the factory:

5. Nature of manufacturing process to be carried on in the factory:

6. Name and description of building / block of building:

7. Year of construction:

8. Manufacturing process to be carried out in the building/ block of building:

9. Number of floors on which workers will be employed:

I certify that I have inspected the building / block of building and carried out the required tests,

the plans of which have been approved by the Chief Inspector-cum-Facilitator in his letter No................

dated ......... and examined the various parts including the foundations with special reference to the

machine, plant etc., that have been installed, I am of the opinion that the building / block of

building which have been constructed/ reconstructed /extended / taken to be use is/are in

accordance with the plans approved by the Chief Inspector-cum-Facilitator in his letter

mentioned above, that it / they/ is/are structurally sound and that its/their stability will not be

endangered by its /their use as factory/part of factory for the manufacture of ............... for which the

machinery, plant, etc. installed are intended.

Signature with Name, address,

Qualification and Contact details

Of Competent Person

Enclosures:

(1) Details of Competency Certificate issued by Chief Inspector-cum-Facilitator

(2) Test reports