Tamsde + () odes - @ cnr gerosige wbsdO:t dndded « ra) GthowiGe Bodo? Undded 48 Seaw o1e0 Opa - 2019.09.27 9A Pars 1: Sec. ()-GAZETTE EXTRAORDINARY OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA 27.09.2019 (Regulation) SCHEDULE II APPLICATION FOR THE ISSUE, EXTENSION OR RENEWAL OF CERTIFICATE OF AUTHORIZATION FOR THE EXAMINATION OF STEAM BOILERS AND OTHER PRESSURE. VESSLES 1. @ Catifiate applied for (Steam Boilers and other Pressure Vessels/Steam Receivers/Air Receivers/Gas Receivers and Gas holder only*) (©) Whether applying for new cetficae, renwal or extension fr other types of Pressure Vesses (2. Full Name ofthe Applicant - “ (B. Business Adéress and Telephone No. (4, Private Address and Telephone No. - 5 05, E-mail: 06, Date of Birth = 7 -(@) Nator () National Identity Card Number 08. General Technical Education (in chronological order) Examinations passed with corresponding dates = ww) . Professional Qualifications - @ Gi) co) 10. Applicant's designation at place of employment if employed Sanned with CamscannerPale th ear eee, 8 cuts ataarsige eBatOrt dndded 98 Dawe 020 og 10190027 Pett iSE. (0: GAZETTE EXTRAORDINARY OF THE DEMOCRATIC. SOCIALIST REDUBLIO OF onl fats yop 019 11. (@) Training undergone inthe particular field for which certificate applied for 3 Give details (©) Name and address of authorized officer or authority under whom the training was received - 12 Experience inthe field for which the certificate applied for 1S. Does te applicant hold any certificate issued by the Chef Factory Inspecting Engineer and iso the number of the Certificate. » 4 Areaof operation opted for examination of Steam boilers and other Pressure Vessels Certificates issued 15. Any other information a ett he foregoing pariculrs ae tre and comes, | am aware thatthe Cerficatisued to me by the FesecenOTy Inspecting Engine is subject to cacellion if the information given under this aplccion wore eos be incorrect ignature of Applicant, Das * Delete what is inapplicable, Sanned with Camscanner