Form 1

[Section 2(1)(l) and sub rule (3) of Rule-4]

Part-I

Form of application for grant of Certificate of Competency to a person under Rule 4

1. Name

2. Date of Birth

Passport size

3. Name of the Organization (if not self-employed)

Photograph

4. Designation

5. Educational qualification (copies of testimonials to be attached)

6. Details of professional experience (in chronological order):

Name of organization Period of service Designation Area of responsibility

7. Membership, if any, of professional bodies

8. (i) Details of facilities (examination, testing, etc.) at his disposal.

(ii) Arrangements for calibrating and maintaining the accuracy of these facilities

9. Purpose for which certificate of competency is sought (section or sections of the Code should be stated)

10. Whether the applicant has been declared a competent person under any statute (if so, the details)

.........................................

11. Any other relevant information .........

12. Declaration by the applicant ...............

I, ............ hereby declare that the information furnished above is true; I undertake˗

(a) that in the event of any changes in the facilities at my disposal (either addition or deletion)

or my leaving the aforesaid organization, I will promptly inform the Chief Inspector-cum-

Facilitator;

(b) to maintain the facilities in good working order, calibrated periodically as per

manufacturer’s instructions or as per National Standards and Relevant Standards; and

(c) notify to the Chief Inspector-cum-Facilitator any change in the facilities (either addition or

deletion).

(d) to fulfill and abide by all the conditions stipulated in the certificate of competency and

instructions issued by the Chief Inspector-cum-Facilitator from time to time.

Place:

Date: Signature of the applicant

Declaration by the Institution (if employed),

I…………............certify that Shri/Smt……………………. whose details are furnished above, is in our

employment and nominate him on behalf of the organization for the purposes of being declared as a

competent person under the Code. I also undertake that I shall—

(a) notify the Chief Inspector-cum-Facilitator in case the competent person leaves our employment;

(b) provide and maintain the facilities in good working order, calibrated periodically as per manufacturer’s

instructions or as per National Standards and Relevant Standards; and

(c) notify to the Chief Inspector-cum-Facilitator any change in the facilities (either addition or deletion).

Date: Signature....................

Designation.................

Contact No………….

e-mail id: ……………

Official Seal

Note.—This declaration should be made by the Managing Director of the company or the partner of the

firm or the proprietor, as the case may be.

PART-II

Form of application of grant of Certificate of Competency to an Institution under Rule-4

1. Name and full address of the Organisation........................

2. Organisation’s status (specify whether Government, Autonomous, Co-operative, Corporate or

Private).......

3. Purpose for which certificate of competency is sought (specify section(s) of the Code).

4. Whether the Organisation has been declared as a competent person under this rule or any other

statute and if so, give details.

5. Particulars of persons employed and possessing qualifications and experience as set out in

Schedule-I annexed to rule 4:

Serial No. Name and Qualifications Experience Section(s) and the Rule under which

designation certificate of competency is sought for

6.Details of facilities (relevant to Item 3 above) and arrangements made for their maintenance and periodic

calibration.

7. Any other relevant information.

8. Declaration..............

I,………………….hereby, on behalf of ………………….certify the details furnished above are

correct to the best of my knowledge, I undertake to—

(i) maintain the facilities in good working order, calibrated periodically as per manufacturer’s

instructions or as per National Standards; and

(ii) to fulfil and abide by all the conditions stipulated in the certificate to competency and

instructions issued by the Chief Inspector-cum-Facilitator from time to time.

Place : Seal and Signature of Head of the Institution

Date : or of the person authorised to sign on behalf

Designation

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