Application for Assessment of

Competency Demonstration Report Please affix

a passport size
(CDR) photograph here

OFFICE USE ONLY

CID

Personal Details
(Please use block letters) (Please tick the appropriate boxes below)

Title Prof Dr Mr Mrs Ms Other

Family Name

Given Names (in full)

Date of Birth / / Country of Birth Sex M F

Postal Address

City Postcode Country

Phone ( ) Fax ( ) Email

Your field of Engineering

Country of qualifications

Indicate occupational category for which you are applying:

Professional Engineer
Engineering Technologist
Engineering Associate

Applicants signature Date / /

Method of Payment
(Please tick the appropriate boxes below)
An assessment fee of AUD$450 must be paid at the time of lodgement of this form. This fee is not refundable.
Note: Any payment from outside Australia must be in favour of Engineers Australia, by a Bank Draft drawn in
Australian Dollars on a bank operating in Australia or by International Credit Card/Money Order.
Bank Draft of AUD$450 drawn on an Australian bank Cheque
International Money Order in Australian dollars Credit Card (see below)
Note: If your application is lodged in Australia, you will be required to pay 10% GST. For Australian residents, the fee
including 10% GST will be AUD$495.

CREDIT CARD DETAILS Please charge my Credit Card (tick one)

Bankcard (Australian only) Visa Mastercard Diners American Express

Credit card No:

Name on credit card Expiry Date /

Amount $ Signature Date / /

Mail to: Overseas Qualifications Assessment, Education and Assessment, Engineers Australia
11 National Circuit, BARTON ACT 2600 AUSTRALIA