Form 2 [See rule 3(3)] (APPLICATION FOR GRANT OF CERTIFICATE OF COMPETENCE TO AN ORGANISATION) 1). Name and full Address of the organization 2). Organization's Status (specify whether Government, autonomous, Co-Operative 3). Purpose for which Competency Certificate is sought (specify Section(s) of the Act) 4). Whether the organization has been declared as a competent person under this or any other statute. If so give details. 5). Particulars of persons employed and possessing qualification and experience as set out in schedule annexed Sl. No. Name and Designation Qualifications. Experience Section(s) and the rules under which competency is sought for 1 2 3 4 5 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 that 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 manufacturers instructions or as per National Standard; and (j) to fulfil and abide by all the conditions stipulated in the certificate of competency and instructions issued by the Chief Inspector of Factories from time to time. Signature of head of the Institution or of the persons authorized to sign on his behalf. Designation Place Date
