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15-3 Permanent Safety Inspector's Permit

MGB permit form for permanent safety inspector

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Republic of the Philippines
Department of Environment and Natural Resources
MINES AND GEOSCIENCES BUREAU
Regional Office No. _____

PERMANENT SAFETY INSPECTOR’S PERMIT

This is to certify that the application of _________________________________
to act as Permanent Safety Inspector per recommendation of the General Superintendent
in a communication dated ___________________ to this Office has been duly noted
and approved. He is, therefore, hereby permitted to practice as such only while in the
employ of ______________________________________________________________
pursuant to the provisions of the Philippine Mining Act of 1995 and the revised
Implementing Rules and Regulations promulgated thereunder and Mines Administrative
Order No. MRD 51, Series of 1991, otherwise known as the Revised Mine Safety Rules
and Regulations.

Given under the seal of this Bureau at _______________ , Philippines, this,
_______ day of __________________ , _________.

REGIONAL DIRECTOR

DRY SEAL

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