ENGINEERING COUNCIL SOUTH AFRICA Form J1.1 OF (03/04/2013) 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 Office Use Website: 2198 Ref.: A F Re R P P L I C A T I O N O R - E G I S T R A T I O N SPECIFIED CATEGORY IN THE OF LIFTING MACHINERY INSPECTOR A NB: Please consult the enclosed Information Sheets (Sheets J1.1 & J1.2) before completing this Application. 1. General Information: Surname: First Names: PHOTOGRAPH (Passport-type. Please paste - Identity No: Date of Birth: do not staple) or Alternatively, insert Passport No. Country of normal *Race Group: Asian Black electronically in and Country: residence: Please tick the JPEG or similar Coloured White applicable block format Home Address: Postal Address: Name & Address of present Employer: LME No: 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: (Highest Level obtained per field) 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/ Justice Of Peace: Applicant: …………………………. ……………………………………… Form J1.2 -2- (03/04/2013)
ENGINEERING COUNCIL OF SOUTH AFRICA (03/04/2013) Form J1.1 Private Bag X 691 Waterview Corner, 1st Floor, BRUMA 2026 2 Ernest Oppenheimer Avenue Tel: (011) 607-9500 Bruma Lake Office Park Office Use Ref.: Fax: (011) 622-9295 BRUMA Email: Johannesburg Website: 2198 A P P L I C A T I O N F O R Re - R E G I S T R A T I O N IN THE SPECIFIED CATEGORY OF A LIFTING MACHINERY INSPECTOR NB: Please consult the enclosed Information Sheets (Sheets J1.1 & J1.2) 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 *Race Group: Please tick the applicable block Asian Black Passport No. and Country: Country of normal residence: Coloured White Home Address: Postal Address: Name & Address of present Employer: LME No: 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: (Highest Level obtained per field) 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: ……………………………………… -2- (03/04/2013) Form J1.2
2J_ECSA_LMI_ReRegistration_Appform.docx