FCERT 02 This form has 2 pages

ENVIRONMENT INSTITUTE OF MALAYSIA FOR OFFICE

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

EXAMINATION APPLICATION FORM

(For resit applicants)

1. *Examination Code: 2. Examination Paper:

CePSWaM Page | 1
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 : - - 2 0

4. Examination Venue:

5. Name :

6. I/C No. :

7. **Date Attend Course: - - 2 0 until - - 2 0

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 4 0- 0 0 0

Payment Method:
Cheque: No:

Please make cheque payable to PENGARAH INSTITUT ALAM SEKITAR MALAYSIA (EiiMAS)
***Please send the invoice to my company: (Attention to: ______________________)

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

Date : 2 0
________ ________________
Signature of applicant
FCERT 02 This form has 2 pages

NOTE;

*CePSWaM = Course for Certified Environmental Professional in Scheduled Waste Management

CePBFO = Course for Certified Environmental Professional in Bag Filters Operation
CePSO = Course for Certified Environmental Professional in Scrubbers Operation
CePTO = Course for Certified Environmental Professional in Transmissometers Operation
CePESPO = Course for Certified Environmental Professional in Electrostatic Precipitators Operation
CePIO = Course for Certified Environmental Professional in Incinerators Operation
CePIS = Course for Certified Environmental Professional in Isokinetic Sampling
CePSBO = Course for Certified Environmental Professional in Spray Booths Operation Page | 2
CePBO = 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.