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

A. List of qualifications acquired

Qualifications	Awarding Institution	Issue Date

B. List of Previous Experience / Project

Project Name	Lifting Equipment Examined	Duration (Start - End Date)	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)

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 Complainant

Yes

Please check the box below to proceed