ENGINEERING COUNCIL SOUTH AFRICA OF RD1.1 Form (25/02/2013) Private Bag X 691 Waterview Corner, 1st Floor, BRUMA 2026 2 Ernest Oppenheimer Avenue Tel: (011) 607-9500 Bruma Lake Office Park Fax: (011) 622-9295 BRUMA Email: Johannesburg Website: 2198 Office Use Ref.: ______________________ A F P P L I C A T I O N O R M RE-REGISTRATION PROFESSIONAL CERTIFICATED ENGINEER AS A 1. General Information: Surname: First Names: RECENT PHOTOGRAPH (Passport-type) Date of Birth: Identity No: Or *Race Group: Asian Black Passport No. Country of normal (Please paste - and Country: residence: do not staple) Please tick the Coloured White applicable block Home Address: Postal Address: Name & Address of present Employer: Tel. No. (Home): Title of Position held: Tel. No. (Employer): Tel. No. (Work): Fax No.: (include area codes) (include area codes) Cell No: E-mail: E-mail: * Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy. 2. Qualifications: (All qualifications at tertiary level other than Government Certificates of Competency.) Copies Office Educational Institution Qualification Year obtained attached use NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner Of Oaths/ Justice Of Peace: Applicant: …………………………. ……………………………………… /...
ENGINEERING COUNCIL OF SOUTH AFRICA (25/02/2013) Form RD1.1 Private Bag X 691 Waterview Corner, 1st Floor, BRUMA 2026 2 Ernest Oppenheimer Avenue Tel: (011) 607-9500 Bruma Lake Office Park Fax: (011) 622-9295 BRUMA Email: Johannesburg Office Use Ref.: ______________________ Website: 2198 A P P L I C A T I O N F O R M RE-REGISTRATION AS A PROFESSIONAL CERTIFICATED ENGINEER 1. General Information: Surname: First Names: RECENT PHOTOGRAPH (Passport-type) Date of Birth: Identity No: Or *Race Group: Please tick the applicable block Asian Black Passport No. and Country: Country of normal residence: (Please paste - do not staple) Coloured White Home Address: Postal Address: Name & Address of present Employer: Tel. No. (Home): Tel. No. (Work): (include area codes) Cell No: E-mail: Title of Position held: Tel. No. (Employer): Fax No.: (include area codes) E-mail: * Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy. 2. Qualifications: (All qualifications at tertiary level other than Government Certificates of Competency.) Educational Institution Qualification Year obtained Copies attached Office use NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner Of Oaths/ Applicant: …………………………. Justice Of Peace: ……………………………………… /...