SHENA - Authorised Examiner Registration form

Authorised Examiner (AE) for Lifting Equipment form

APPLICANT'S DETAILS

Application Type*

New* Renewal*

Professional Category*

Professional Engineer* Chartered 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 and Months working in Current Job Position

Name of Company*

Company's Address*

SUPPORTING DOCUMENTS

SUPPORTING DOCUMENTS FOR AUTHORISED EXAMINER (LIFTING EQUIPMENT)

Documents to be uploaded

Upload document(s)

Copy of IC (both sides) or Passport*

Valid Practicing Certificate from BAPEQS (Mandatory for Professional Engineers)

Company Registration Certificate (Mandatory for TPIA)

Appointment or Nomination Letter from the Employer indicating role as an Authorised Examiner for lifting equipment

Mandatory for inspectors employed under TPIA; Optional for Professional Engineers and Chartered Engineers

Latest Curriculum Vitae*

Please indicate: 1) applicant's qualifications and awarding institution, including issuance date 2) project list/job experience on lifting equipment with duration of the project

Highest Academic Certificate*

Technical Training Certificates*

Copy of Medical Report from a Registered Medical Practitioner

Mandatory for applicants above the age of 60 years old

Sample of certificate issued after performing thorough examination of lifting equipment*

Sample of inspection report used when performing thorough examination of lifting equipment*

Checklist used to conduct the thorough examination of lifting equipment*

Standard Operating Procedure/ Process Flow of performing thorough examination*

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

Please check the box below to proceed