[[1]FORM No. 3

(Prescribed under Rule No. 3 (4))

Certificate of Stability 

1.  Name of the factory

2.  Village, Town and District in which the factory is situated

3.  Full postal address of the factory

4.  Name of the occupier of the factory

5.  Nature of manufacturing process to be carried on in the factory

6.  Number of floors on which workers will be employed.

          I certify that I have Inspected the building/buildings, the plans of which have been approved by the Chief Inspector in his letter No.…………………………….Dated……………..and examined the various parts including the foundations with special reference to the machinery, plant, etc., that have been installed I am of the opinion that the building/building which has/have been constructed/reconstructed/extended/taken into use is/are in accordance with the plans approved by the Chief Inspector in his letter mentioned above, that it/they is/are structurally sound and that its/their stability will not be endangered by its/their use as a factory/part of a factory for the manufacture of ………………………………………..for which machinery, plant, etc. installed are intended

Signature

 Qualification

 Address

 Date

 If employed by a Company or association,
name and address of the company
or association]