CSWIP LOG BOOK AND RUBBER STAMP

Please note that a log book will be a mandatory requirement at the time of
your next renewal - so if you do not already have a CSWIP log book it is
strongly recommended that you purchase one

TWI Certification is pleased to offer all current CSWIP certificate holders a self-inking desk rubber
stamp, to be used to publicly demonstrate your level of qualification(s) on relevant documentation.
The stamp will display your name, candidate number and level of Certification(s).

Please tick which you require: (Please note this form is not required if you have applied for Registration)

Log Book Only 19 (Inclusive of VAT)

CSWIP Desk Stamp Only 37 (Inclusive of VAT)
Log Book and CSWIP Desk Stamp 50 (Inclusive of VAT)
Log Book, CSWIP Desk Stamp and Pocket
62 (Inclusive of VAT)
Stamp

FULL NAME:

DATE OF BIRTH:

ADDRESS:

CSWIP CERTIFICATE NUMBER(S):

CONTACT TELEPHONE NO:

CONTACT EMAIL ADDRESS:
SIGNED: DATE:

Cheque / Demand Draft to be made payable to TWI Certification or if you wish to pay by credit card kindly
complete below (Please note that for security reasons we are unable to accept applications by email if you are
paying by credit/debit card, please send by post or fax to +44 1223 894219, thank you for your cooperation in
this matter. If sent by email this will be deleted and we will not be able to process your application).
If paying by Credit Card please quote card number, expiry date and security code no:

___________________________________________________ EXPIRY DATE ______________

Last 3 digits of Security Code on reverse of card _________

(For Amex holders the 4 digit code on the front of the card)

SWITCH ONLY ISSUE NO: _________ START DATE: ___________

DAC/CSWIP/S735/ 2015