ENGINEERING COUNCIL SOUTH AFRICA E1.1 OF Form (03/04/2013) Private Bag X 691 Waterview Corner, 1st Floor, BRUMA Tel: (011) 607-9500 Fax: (011) 622-9295 BRUMA Email: Website: 2198 Office Use Ref.: ______________________ A F P P L I C A T I O N O R M Application Registration for as: (Tick appropriate block ) Candidate Engineer Please include a certified copy of your BSc Eng/B Eng Degree Please consult the enclosed Candidate Engineering Technologist Information Sheet (Sheet E1.1 & 2) before completing this application. Please include certified copies of your National Diploma and B Tech Degree certificates and include certified copies of your statement of results for the N Dip and the B Tech Candidate Certificated Engineer Please include certified copies of your GCC Candidate Engineering Technician Please include a certified copy of your National Diploma Certificate 1. General Information: Surname: First Names: Date of birth: Identity No. Or Passport No: *Race Group: Asian Black *Gender Group Mr.______ Mrs._____Miss_____ Col.______ Please tick the Please tick the Coloured White applicable block applicable block Ms. ______ Dr. ______Prof. _____ Hon.______ Address: Country of normal residence: Home Tel. No.: (Include area codes) Cell no.: Residential Address: Work Tel. No.: Fax No.: E-mail: * Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy. 2. Examinations Passed: Date of final Examination 2.1 Educational Institution Office use Qualifications attained month & year Recognised Not recognised Part NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner of Oaths/ Applicant: Justice of Peace: ………………………………….. …………………………………… E1.2 Form (03/04/2013)
ENGINEERING COUNCIL OF SOUTH AFRICA (03/04/2013) Form E1.1 Private Bag X 691 Waterview Corner, 1st Floor, BRUMA Tel: (011) 607-9500 Fax: (011) 622-9295 BRUMA Office Use Ref.: ______________________ Email: Website: 2198 A P P L I C A T I O N F O R M Application for Registration as: (Tick appropriate block ) Please consult the enclosed Information Sheet (Sheet E1.1 & 2) before completing this application. Candidate Engineer Please include a certified copy of your BSc Eng/B Eng Degree Candidate Engineering Technologist Please include certified copies of your National Diploma and B Tech Degree certificates and include certified copies of your statement of results for the N Dip and the B Tech Candidate Certificated Engineer Please include certified copies of your GCC Candidate Engineering Technician Please include a certified copy of your National Diploma Certificate 1. General Information: Surname: First Names: Date of birth: Identity No. Or Passport No: *Race Group: Please tick the applicable block Asian Black *Gender Group Please tick the applicable block Mr.______ Mrs._____Miss_____ Col.______ Ms. ______ Dr. ______Prof. _____ Hon.______ Coloured White Address: Country of normal residence: Home Tel. No.: (Include area codes) Cell no.: Residential Address: Work Tel. No.: Fax No.: E-mail: * Completion of this section is necessary in order to accurately reflect equity statistics in terms of Government Policy. 2. Examinations Passed: 2.1 Educational Institution Qualifications attained Date of final Examination month & year Office use Recognised Not recognised Part NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner of Oaths/ Applicant: ………………………………….. Justice of Peace: …………………………………… (03/04/2013) Form E1.2
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