FORM I-A [Prescribed under sub-Rule (3) of Rule 2-A] Form of application for grant of certificate of competency to an Institution. 1. Name and full address of the Organisation. 2. Organization's status (specify whether Government, autonomous, cooperative, corporate or private). 3. Purpose for which competency Certificate is sought [specify Section(s) of the Act]. 4. Whether the organisation 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 to sub-Rule (1) of Rule 2-A. Serial No. Name and Qualification Experience Station(s) and Designation the Rules under which competency is sought for 1. 2. 6. Details of facilities (relevant to item 3 above) and arrangements made for their maintenance and calibration periodically. 7. Any other relevant information. 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 fulfill and abide by all the conditions stipulated in the certificate of Page 103 of 151 competency and instruction 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 and Date: Page 104 of 151
