ENGINEERING COUNCIL SOUTH AFRICA C1.1 OF Form (2014-07-17) 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 PROFESSIONAL ENGINEERING TECHNICIAN REGISTRATION AS A NB: Please consult the Information Sheets (Sheets C1.1 & C1.2) before completing this Application. 1. General Information: Surname: First Names: PHOTOGRAPH (Passport-type. Please paste - do not staple) Identity No: Date of Birth: Alternatively, insert or electronically in JPEG or similar Passport No. Country of normal *Gender *Race Asian: Black: format and Country: residence: Group M: F: Coloured: White: 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 to accurately reflect equity statistics in terms of Government Policy. Please cross applicable blocks. 2. Qualifications: (All qualifications at tertiary level) (List of subjects to be provided on Form C1.3 AR) Attendance Date of final Office Educational Institution Qualification from to examination use NB: Kindly initial this page in the presence of a Commissioner of Oaths / Justice of Peace. Commissioner Of Oaths/ Applicant: Justice Of Peace: …………………………. ………………………………………
ENGINEERING COUNCIL OF SOUTH AFRICA (2014-07-17) Form C1.1 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 REGISTRATION AS A PROFESSIONAL ENGINEERING TECHNICIAN NB: Please consult the Information Sheets (Sheets C1.1 & C1.2) before completing this Application. 1. General Information: Surname: First Names: PHOTOGRAPH (Passport-type. Please paste - do not staple) Alternatively, insert electronically in JPEG or similar format Date of Birth: Identity No: or *Gender *Race Group Asian: Black: Passport No. and Country: Country of normal residence: M: F: 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 to accurately reflect equity statistics in terms of Government Policy. Please cross applicable blocks. 2. Qualifications: (All qualifications at tertiary level) (List of subjects to be provided on Form C1.3 AR) Educational Institution Qualification Attendance from to Date of final examination 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: ………………………………………
PN-Guide.docx