8/8/2019 Examination Application Form

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ENVIRONMENT INSTITUTE OF MALAYSIAEiiiiMAS

Phone : 03-8926 1500Fax : 03-8926 1700 Applicant No:(Attn. : Mr. Wan Khairuldin Wan Ismail)

1. *Examination Code: 2. Examination Paper:

CePSWaM

CePBFO Written Examination

CePSO

CePTO Practical Examination

CePESPO

CePIO (For re-sit Practical or Written or Both RM400 will be charged)

CePIS

CePSBO

CePBO

CePIETSO BP

CePIETSO PCP

dd mm yyyy

3. Examination Date : - -

4. Examination Venue:

5. Name :

6. I/C No. :

7. **Date Attend Course: - - until - -

8. Mailing Address :

9. Invoicing Address :

(Company Name

and address)

10. Contact Tel No (O): -_________________________ H/Phone: - _______________________________

Fax No (O): - _________________________ E-mail: - ________________________________

11. Examination Fees: RM -

Payment Method:Cheque: No:

Please make cheque payable to PENGARAH INSTITUT ALAM SEKITAR MALAYSIA (EiiiiMAS)

***Please send the invoice to my company: (Attention to: ______________________)

12. I hereby certify that the above statements are true and complete.

Date :________ ________________

Signature of applicant

EXAMINATION APPLICATION FORM

(For resit applicants)

FOR OFFICE

USE ONLY

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8/8/2019 Examination Application Form

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FCERT 02 This form has 2 pages

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NOTE;

*CePSWaM= Course for Certified Environmental Professional in Scheduled Waste ManagementCePBFO= Course for Certified Environmental Professional in Bag Filters OperationCePSO= Course for Certified Environmental Professional in Scrubbers OperationCePTO= Course for Certified Environmental Professional in Transmissometers OperationCePESPO= Course for Certified Environmental Professional in Electrostatic Precipitators OperationCePIO= Course for Certified Environmental Professional in Incinerators OperationCePIS= Course for Certified Environmental Professional in Isokinetic SamplingCePSBO= Course for Certified Environmental Professional in Spray Booths OperationCePBO= Course for Certified Environmental Professional in Boiler Operation

CePIETSO BP = Course for Certified Environmental Professional in the Operation of Industrial Effluent Treatment Systems(Biological Treatment Process)CePIETSO PCP = Course for Certified Environmental Professional in the Operation of Industrial Effluent Treatment Systems(Physical Chemical Treatment Process)

** Please submit together with Certificate of Attendance).

***If invoice is required. Personal cheque will not be accepted. Examination fee has to be submitted together with this application.Fees are not refundable.