Professional Documents
Culture Documents
: 1
Date: 13.11.2016
FORM A3-1
FORM A3-1
Applicant's
APPLICATION FOR REGISTRATION AS AN current
INSPECTOR OF WORKS passport size
Section 10E of the Registration of Engineers Act 1967 (Revised 2015) photo
Name.........................................................................................................................................................
Gender: *Male Date of Birth : …......................................................
Tel. No. : ....................................... Mobile Phone No.: ............................. Fax No. : ...........................
Qualifications : .........................................................................................................................................
…...............................................................................................................................................................
FORM A3-1
APPENDIX - A
BRANCH OF ENGINEERING
Listed below are branches of engineering registered by the Board of Engineers Malaysia.
Civil Mechanical
FORM A3-1
Suffix : ..………………………………………………
Rev. No.: 1
Date: 13.11.2016
BEM/CL/APP/13
11. A copy of passport size photograph (please write your name at the
back of the photograph).
Remarks :
….............................................................................................................................................................................
I confirm that I have completed the above and fulfil BEM For Office Use Only
requirements.
Signature of Officer-in-charge
Board of Engineers Malaysia
…........................................................................................ ….....................................................................
(Signature of Applicant) Date :
Date :