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APEC ENGINEER

INDONESIAN MONITORING COMMITTEE


Secretariat : Institute of Engineers, Indonesia (PII)
Jl. Halimun 39 Jakarta Selatan, Indonesia
Telephone : +62 21 8352180 Fax : +62 21 83700663
e-mail : info@pii.or.id

ASSESSMENT OF APPLICANT
FOR APEC ENGINEER REGISTRATION

Name of Applicant

APEC Engineer Qualification recommendation, place and date obtained


( to be filled by the Secretariat of APEC Monitoring Committee upon its approval )
Registered Engineer Registration No.
: ..
Registered Engineer Registration Date
:
APEC Engineer Register Discipline
:
Certified Compliance with APEC Engineer Criteria:
1. Education
University / Institution :
Academic Degree
:
Discipline
:

City :
Year :

2. Association Professional Certification


Certificate No
: .
Issued date : .
Discipline
:
Years of practical experience since graduation at time of certification : .
3. Within the practical experience period, has spent at least two years in responsible
charge of significant engineering work
Period :
Project :
Position :
Period :
Project :
Position :
Period :
Project :
Position :
Projects claimed is in accordance with its details as described in the Requester
Application (FAIP) for Professional Certification to the Professional Association
Certification Body
4. Acknowledge that, on renewal of my Profesional Association membership, I will be
reporting to the Professional Association Certification Body issuing my Professional

Engineer Certificate, my Annual Continuing Professional Development Activities


which I have undertaken to maintain my competency as required by the Certification
Body.
I hereby declare that all statements above are true and correct and I will abide to the Professional
Association Codes of Conducts and Code of Ethics in performing my Professional Obligations.
.

Jakarta, 2009
Assesment Requester,

( name )

Recommendation for Registration in APEC Engineer Register :


o Approved
o Not Approved
Tick circle as appropriate

Ir. .
Secretary of the Indonesian APEC Engineer Monitoring Committee