SHENA - Approved Examiner Registration form

APPLICANT'S DETAILS

Application Type*

New* Renewal*

Status*

Professional Engineer* Inspector from Third Party Inspection Agency*

Applicant's Name (as per IC / Passport)*

IC No. (For Brunei Citizen, Permanent Resident or Temporary Resident) or Passport No. (Foreign Application)*

IC Colour*

Date of Birth*

Nationality*

Gender*

Male* Female*

Residential Address*

Mailing Address*

Contact No. (Mobile)*

Contact No. (Office)*

E-mail Address*

WORKPLACE DETAILS

Current Job Position/ Title*

No. of years in Current Designation*

Task and Responsibilities

Name of Company*

Work Activity*

Company's Address*

QUALIFICATION & EXPERIENCE DETAILS

Qualifications	Awarding Institution	Issue Date

Project Name	Lifting Equipment Examined	Duration Start End	Total Duration in Years and Months

SUPPORTING DOCUMENTS (FORMAT PDF, JPEG, BMP, GIF)

SUPPORTING DOCUMENTS FOR AUTHORISED EXAMINER (LIFTING EQUIPMENT)

Documents to be uploaded

Upload document(s)

Valid Practicing Certificate from BAPEQS (for Professional Engineer)*

for local application: ROCBN certificate. for international application: Registration letter or relevant documents from a local agent in charge on behalf of the international company.

Copy of IC (both sides) or Passport*

Latest Curriculum Vitae (Please indicate job experience on lifting equipment examination/ maintenance)*

Copy of Highest Academic Certificates*

Copy of Technical Training Certificates*

Letter of declaration/ appointment/ nomination from the company which indicate your appointment as Authorised Examiner (if applicable)*

Copy of medical report from a registered medical practitioner (only for applicants above the age of 60 years old)

ADDITIONAL EVIDENCE

Sample of test reports, inspection reports and certificates, or any technical reports that has been performed previously*

I, declare that all particulars and information provided in this application and the documents attached hereto are true to the best of my knowledge and belief, and I understand that the Safety, Health and Environment National Authority (SHENA) reserves the right to reject this application if, at any stage, the information provided is false and incorrect. Should verification be required on any information provided in this application, I hereby authorise SHENA to carry out the necessary investigations.

Declaration of Applicant

I agree

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