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Practising Certificate Application Form

This document is an application form from the Engineers Registration Board of Botswana for a practicing certificate. The form requests personal details of the applicant such as name, nationality, ID number, and contact information. It also asks for current employment details, engineering category and discipline, and number of continuing professional development credits attained in the current year. The applicant must declare that they will abide by the provisions of the Engineers Registration Act and certify that the information provided is true and correct. The bottom section is for office use only to record details of when the application was received, certificate issued and expires, amount paid, and issued by.

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Percy Goitsemang
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1K views

Practising Certificate Application Form

This document is an application form from the Engineers Registration Board of Botswana for a practicing certificate. The form requests personal details of the applicant such as name, nationality, ID number, and contact information. It also asks for current employment details, engineering category and discipline, and number of continuing professional development credits attained in the current year. The applicant must declare that they will abide by the provisions of the Engineers Registration Act and certify that the information provided is true and correct. The bottom section is for office use only to record details of when the application was received, certificate issued and expires, amount paid, and issued by.

Uploaded by

Percy Goitsemang
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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FORM ERB/REG/F2.1/1.

1
ENGINEERS REGISTRATION BOARD
Postal Address Physical Address
P. O. Box 1909 Unit 3 & 4, Plot 145
AAD Poso House Kgale Lake View Office Park
Gaborone Gaborone
Tel: +267 391 4446
Botswana
Fax: +267 397 3626
email: [email protected] Web: www.erb.org.bw

APPLICATION FOR PRACTISING CERTIFICATE


A1.1: PERSONAL DETAILS
1: TITLE 2: FIRST AND MIDDLE NAMES 3: SURNAME 4: GENDER

M F

7: PASSPORT DETAILS
5: NATIONALITY 6: ID NO. (for Botswana Citizens)
(Non-Botswana Citizens)
Passport No.
Expiry Date:

8: POSTAL ADDRESS 9: PHYSICAL ADDRESS 10: CONTACT DETAILS


Tel:
Mobile:
email:

A1.2: CURRENT EMPLOYMENT DETAILS


11: NAME OF ORGANISATION 12: DESIGNATION 13: CONTACT DETAILS
Tel:
Fax:

Website

A1.3: ENGINEERING CATEGORY & DISCIPLINE FOR PRACTISING


14.1: ENGINEERING CATEGORY 14.2: ENGINEERING DISCIPLINE 14.3: CURRENT CERTIFICATE EXPIRY DATE
(e.g. Professional/Graduate) (e.g. Electrical, Civil, etc.) (if applying for renewal)

A1.4: NUMBER OF CPD CREDITS ATTAINED


15: CPD CREDITS ATTAINED IN CURRENT YEAR
NB: Attach CPD logbook

DECLARATION
I hereby apply for a practicing certificate and undertake to abide by all provisions of the Engineers Registration Act, 2009, and any
regulations and by-laws made there under including Code of Professional Conduct and Ethics. I certify that, to the best of my knowledge,
the information contained herein is true and correct.

Date: Signature of Applicant:

FOR OFFICE USE ONLY


Date Application Received:
Date Certificate Issued:
Certificate Expiry Date:
Amount Paid:
Issued by (Name and Signature):

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