Form AE-10

(See rule 113 of the Explosives Rules, 2008) Application for grant or amendment of Shot firers certificate to carry out blasting
of explosives in areas not coming under Mines Act, 1952.
I,.. apply for approval or grant or amendment(1) of

Shot firers certificate

1. (a) Name in which certificate is required to be granted (b)Age (c) Postal address: .

.City .. DistrictStatePin code...

Police Station Railway Station / Steamer Ghat.

PhoneE-mail..Fax
(d) Residential address:

.City .. DistrictStatePin code...

Police Station Railway Station / Steamer Ghat.

PhoneE-mail..Fax
(e) Whether the applicant is employer 2. employed; if yes, name and address of the

Qualifications and experience of applicant ( attach documentary evidence)

. .

Field of specialisation

Particulars of no objection certificate.

number.................dated....... issued by

4 Particular of category and type for which certificate is required (see note below): 5 I certify that (i) the above particulars are true and correct. (ii) I am aware that permit to conduct blasting operation is required to be obtained by me from the local authority before conducting blasting. (iii) I am aware that if explosives are illegally transferred by me to any unauthorised person(s), it may lead to terrorist activity for which I shall commit a punishable offence. (iv) Annousement before blasting and after sunrise and before sunset.

Date. (Signature applicant) Note(1) Please enclose certified copies of certificates showing Date of Birth, Educational qualifications, experience and medical fitness certificate. (2) Category and type of blasting as per rule 107: Class Category Type of blasting permitted A Unlimited All types of blasting B General aboveground All phases of aboveground blasting operation C General underground All phases of underground blasting operation D Demolition All phases of blasting in demolition projects E F G Seismic Agricultural Special
under the law.

of

All phases of blasting in seismic prospecting or production All phase of blasting in agricultural and well sinking Blasting for special purpose not covered under the above categories

Statutory Warning: Mishandling and misuse of explosives shall constitute serious criminal offence