FORM OF APPLICATION FOR GRANT OF APPROVAL AS

“COMPETANT PERSON” UNDER RULE 2 (j) OF THE BUILDING AND OTHER CONSTRUCTION WORKERS (REGULATION OF EMPLOYMENT AND CONDITIONS OF SERVICE) CENTRAL RULES, 1998

A. PERSONAL DATA

1. NAME IN FULL :

(MR/MRS/MS)

2. FATHER’S / HUSBAND’S :

NAME IN FULL

3. ADDRESS IN FULL :

4. DATE OF BIRTH :

5. NAME OF THE TESTING :

ESTABLISHMENT / ORGANISATION

(WHERE PRESENTLY EMPLOYED)

6. DESIGNATION / POST HELD :

7. EDUCATIONAL QUALIFICATION :

(COPIES OF SUPPORTING DOCU-

MENTS TO BE ATTACHED)

8. DETAILS OF PROFESIONAL :

EXPERIENCE

Sl. No.	Name of Organisation/ Testing Establishment	Period of Service		Total Experience (YY/MM/DD)	Designation/ Post Held	Area of Responsibility/ Activity
		From	To

9. MEMBERSHIP, IF ANY, OF :

PROFESSIONAL BODIES

B. TESTING ESTABLISHMENT DATA

10. REGISTERED NAME OF THE :

TESTING ESTABLISHMENT/

ORGANISATION

11. TELEPHONE NO. :

12. TELEX NO. :

13. FAX NO. :

14. DETAILS FOR FACILITIES FOR :

TESTING / EXAMINATION, ETC,

AVAILABLE

15. DETAILS OF RECENT CALIBRATION :

CARRIED OUT

(COPIES TO BE ATTACHED)

(a) NAME OF THE FIRM WHERE :

CALIBRATION CARRIED OUT

(B) CERTIFICATE NO. AND DATE :

C. MISCELLANEOUS

16. PURPOSE FOR WHICH COMPETENCY : TESTING, EXAMINATION AND

IS REQUIRED CERTIFICATION OF

(TICK MARK THE APPROPRIATE BOX)

(i) LIFTING APPLIANCES

UNDER RULE 56 & 62

(ii) LIFTING GEARS

UNDER RULE 70 & 72

(iii) WIRE ROPES

UNDER RULE 71 & 62

(iv) HEAT TREATMENT

OF LIFTING GEARS

UNDER RULE 72

(v) PRESSURE PLANTS &

EQUIPMENT

UNDER RULE 207

17. WHETHER THE APPLICANT HAS BEEN :

DECLARED AS A COMPETENT PERSON

UNDER ANY OTHER STATUTES

(TICK MARK THE APPLICABLE BOX)

(i) THE FACTORIES ACT, 1948

(ii) THE MINES ACT, 1952,

(iii) THE DOCK WORKERS (SAFETY, HEALTH & WELFARE) ACT, 1986

(IF SO, GIVE THE DETAILS THERE OF) :

18. ANY OTHER RELEVANT INFORMATION :

D. FOR RENEWAL OF COMPETENCY

19. COMPETENCY CERTIFICATE NO. :

AND DATE UNDER WHICH

COMPETENCY WAS GIVEN

20. PURPOSE FOR WHICH COMPETENCY :

WAS GIVEN

21. DATE UPTO WHICH COMPETENCY IS :

/ WAS VALID

22. ANY ADDITION IN TESTING :

FACILITIES AFTER THE LAST

COMPETENCY AWARDED

E. DECLARATION BY THE APPLICANT

I, hereby declare that the information furnished above by me is true. Further, I undertake :

a) that, in the event of any change in the facilities either addition or deletion or my leaving the aforesaid testing establishment / organization, I will promptly inform the Director General, DGFASLI;

b) to maintain the facilities in good working order, as per manufacturer’s instructions and calibrate it periodically; and

c) to fulfill and abide by all the conditions stipulated in the certificate of competency and relevant provisions under the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Central Rules, 1998

Place :

Date : Signature of the Applicant

F. DECLARATION BY THE OWNER / HEAD OF THE TESTING ESTABLISHMENT/ ORGANISATION.

We ., certify that Shri. whose details are furnished above, is in our employment and I / We nominate him on behalf of the testing establishment/ organization, for the purpose of being declared as a competent person under Rule 2 (j) of the Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Central Rules, 1998.

I / We also undertake that I / We shall :

a) notify the Director General, DGFASLI, in case the competent person leaves our

employment ;

b) provide and maintain in good working order all the testing facilities at our disposal

as mentioned above; and

c) notify the Director General, DGFASLI, any change in the facilities (either addition

or deletion).

Further, I / We certify that the information furnished in this application is correct.

PLACE : Signature :

Name :

DATE : Designation :

* OFFICE SEAL