FORM B
[See rule 18 (1)]

Certificate of  Refresher Training/Training of special categories workmen
I hereby certify that Shri/Shrimati………s/o/d/o/w/o……….Village……Thana (Police
Station)………P.O……District………State……has between………duly under gone
the refresher/special training required under Chapter IV/Chapter V of the Mines…….Vocational Training-Rules, 1966, for! 3……..

Space for affixing the photograph of the person trained.

Signature……………………………
Date………………..Training Officer
.......................Mine/Training Centre
(Specify below whether non-gassy or
 gassy mine).
Signature or left hand thumb-
 impression of the person trained.
Countersignature of } …………………….
the Agent or Manager. }…………………….
--------------------------
1. Delete whichever is not applicable.
2. Insert dates between which the training was undergone.
3. Specify here the refresher special training under gone.