FORM 1-A
Notice of opening
(See Regulation 3)
From
(Owner, agent or manager)
Name
Postal address
District
State
PIN
Mobile Number
Telephone No. (Land line)
Fax Number
Email ID
To
1. The Chief Inspector of Mines, DGMS, Dhanbad - 826001
2. The Regional Inspector of Mines
3. The District Magistrate
Sir,
I have to furnish the following particulars in respect of opening of
1. Name of mine….
2. Name of owner/company/firm/association…
3. Location of the mine
latitude and longitude*
Lease number(s)-
Village/area/road–
Post Office-
Police Station-
Sub-Division (Taluq)/Tehsil-
Railway station(nearest)-
District-
State-
PIN-
4. Labour Identification Number (LIN), if any
5. Mine Code, if any
6. Details of Owner, Agent, Manager
Sl. Particulars Owner Nominated Agent Manager
No. Owner
i. Name
ii. Father’s name
iii. Aadhaar no.*
iv. Address
Village/area/road–
Post Office-
Police Station-
Sub-Division (Taluq)/Tehsil-
Railway station(nearest)-
District-
State-
PIN-
v. Mobile Number
vi. Telephone number(Landline with STD code)
vii. Fax number
viii. Email ID
7. Date on which it is intended to open the mine(DD/MM/YYYY)
8. Plan(s) under reg. 3(1) and 65(1)(a) of CMR,2017
enclosed: Yes/No; 8.1 If yes, specify plans Nos. with
date…………………………
9. Safety Management Plan (SMP) under Regulation 104 of CMR,
2017 enclosed-Yes/No;
9.1 If yes, specify reference number with date…………………………
10. Actual date of opening (DD/MM/YYYY)
Yours faithfully
Signature:
Designation: Owner / Agent /
Manager
Date:
* Optional
…………………………………………………………………………………………………………
…………………