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Ministry of Labour and Employment: (Name of Issuing Official) (Name of Mine) (

This document is a pro forma experience certificate issued by mine managers, agents, or owners to certify a candidate's practical work experience in a mine. It contains fields to enter the candidate's personal details, dates of employment, work duties performed, and details of their experience including location, time periods, and average outputs. The issuing authority certifies that the candidate has the required experience for a certificate of competency and is of good character to be granted the certificate.

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Subhajit Gorai
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1K views2 pages

Ministry of Labour and Employment: (Name of Issuing Official) (Name of Mine) (

This document is a pro forma experience certificate issued by mine managers, agents, or owners to certify a candidate's practical work experience in a mine. It contains fields to enter the candidate's personal details, dates of employment, work duties performed, and details of their experience including location, time periods, and average outputs. The issuing authority certifies that the candidate has the required experience for a certificate of competency and is of good character to be granted the certificate.

Uploaded by

Subhajit Gorai
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

PROFORMA OF EXPERIENCE CERTIFICATE IN A MINE

No.: ………………… Date: ……………

GOVERNMENT OF INDIA
MINISTRY OF LABOUR AND EMPLOYMENT
DIRECTORATE GENERAL OF MINES SAFETY

Certificate of practical experience granted by the Manager / Agent / Owner to a candidate for
grant of Manager's / Surveyor's / Overman's / Foreman’s / Sirdar's / Mate's / Blaster's*
Certificate of Competency under *the Coal Mines Regulations, 2017 / *the Metalliferous Mines
Regulations, 1961.

I, (Name of Issuing official) being the *Manager/ Agent▲ / Owner▲

of (Name of Mine) ,‘#’ (Mineral) Mine, Labour Identification

Number (LIN) - ______________, belonging to ( Owner/Company) ,

do hereby certify that *Shri / Kumari / Smt. (Name of Candidate) (whose

signature is appended below) *Son / Daughter / Wife of ______________________________, has

worked in the above mine from ______________ to ______________. During *his/ her term of

aforesaid work, *he / she has obtained practical experience as detailed overleaf. The duties connected

with *his/ her work have been efficiently performed by *him / her.

I believe *him / her to be of good character, fit and proper person for grant of certificate of
competency.
.......................................................................................................
Date: (Signature of Issuing Authority)

Name of Issuing Authority:

Designation:

Official Seal: Statutory Certificate held:

Statutory Certificate No.:

Post Office:

District:

State:

Pin:

-------------------------------
(Signature of Candidate)

Page 1 of 2
S. Particulars of practical Place of experience Period of practical Total experience
No. experience (Belowground experience
/Opencast / From (c) To Years Months Days
Aboveground)

Grand Total

During the above period In below ground In opencast In all


workings workings
Average Monthly Output

Average Daily Employment

........................................................................
(Signature of Issuing Authority with date)

Official seal: _______________________________________


Instructions:-
Particulars of practical experience shall meet the requirements for the certificate applied for, as
prescribed in the bye laws for grant of certificate on exemption basis & conduct of examinations for the
Certificate.
Note:
1. Only Owner▲/ Agent▲/ Manager can issue the above Experience certificate. Certificate, not issued by or not
having the official seal of the Manager / Agent / Owner of the mine, shall not be valid.
2. ▲ Agent or Owner shall issue the experience certificate to the Mine manager only.
3. *Delete/Strike Out whichever is not applicable;
4. # (State Name of Mineral);

Page 2 of 2

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