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State of Kerala - Section
Section 2A in Kerala Factories Rules, 1957
2A. Competent Person.
| 1 | Name | : | ||
| 2 | Date of Birth | : | ||
| 3 | Name of the Organization (if not self-employed) | : | ||
| 4 | Designation | : | ||
| 5 | Educationalqualification (copies of testimonials to be attached)Details of professional experience (inChronological order) | : | ||
| Name of the organization | Period of Service | Designation | Area of Responsibility | |
| 7 | Membership if any, of professional bodies | : | ||
| 8 | (i) Details of facilities(examination, testingetc.) at his disposal | : | ||
| (ii) Arrangements for calibrating andmaintaining the accuracy of these facilities | : | |||
| 9 | Purpose of which competency certificate issought | : | ||
| (section or sections of the Act should bestated) | ||||
| 10 | Whether the applicant has been declared ascompetent person under any statue (if so, the details) | : | ||
| 11 | Any other relevant information | : | ||
| 12 | Declaration by the applicant |
| Place: | Signature | |
| Name and designation, | ||
| Date.: | Office Seal | Tel No. |
| 1. | Name and full address of Organization | : | ||
| 2. | Organization's status [specify whetherGovernment, Autonomous, Co- operative (Corporate or Private)] | : | ||
| 3. | Purpose for which Competency Certificate isSought [Specify section (s) of the Act | : | ||
| 4. | Whether the organization has been declared as acompetent person under this or any other statute. If so, givedetails | : | ||
| 5. | Particulars of persons employed and possessing qualification and experience as set out in Schedule annexed to sub-rule (1) of Rule 2A |
| Sl. No | Name & Designation | Qualifications (Testimonial to be rules underwhich attached | Experience | Section(s) and the rules under which iscompetency sought for | Signature |
| 1 | 2 | 3 | 4 | 5 | 6 |
| 1.2. |
| 6. | Details of facilities (relevant to item 3 above) and arrangements made for their maintenance and periodical calibration |
| 7. | Any other relevant information |
| Place : | Signature of Head of the Institution |
| Date : | or of the persons authorized to sign on hisbehalf. |
| Designation |
| Name | Sections Applicable | |
| 1. | ||
| 2. | ||
| 3. |
| Station : | Office Seal | Signature of the Chief Inspector |
| Date : |