FORM A
[See rule 28 (1)]

Certificate of training for employment in a mine on surface and in open-cast workings
below around in non-gassy/gassy mine
I hereby certify1 Shri/Shrimati………………………………………..
2s/o/d/o/w/o………………………..(Thana) Police Station ………… P.0
District…………..State………..between2………… duly undergone the training required
under Chapter III of the Mines Vocational Training Rules, 1966, for employment in a mine on surface and in open cast working and below ground in non- gassy/gassy mines.
Signed……………….
Space for affixing the
photograph of the person
trained.
Date…………….Training Officer
Mine/Training Centre.
                                     (Specify below whether non-gassy or gassy mine).
...........................                                                      ……………..
Signature or left hand                                                 Counter-signature of the
thumb-impression of the person trained.                     Agent of Manager.
1. Delete whichever is not applicable.
2. Insert dates between which the training was undergone.