Statement of Attestation – This form must be filled out.

Submit this attestation from the employer in which the latest certification was attained. A minimum of 2 signatures shall
be provided for certification. The following signed statement attests to the accuracy and validity of the documentation
evidence submitted for certification. As an Employer, Level III, NDT Supervisor or Customer, I have reviewed the
documentation and understand that any misrepresentation would be considered a breach of the ASNT Code of Ethics.

Employer – A management level representa i e f he c m an ha ing di ec kn ledge f he a lican d ie and

being familia i h he c m an ce ifica i n ce .

Certifying Level III or NDT Supervisor The Level III directly responsible for the certification of the applicant. May be
an ASNT III, ACCP III, Company III, Responsible III, Level III of Record or 3 rd Party Level III. When working in a position
comparable to that of Level II, the NDT Supervisor is the person most responsible for direction of the day to day work of
the applicant.

Customer (Self-Employed Only) – M be a c me ha ing di ec kn ledge f he a lican in ec i n d ie and

abilities. Customer attests that the applicant has performed testing in the method applied for during the specific time-
period.

NDT Engineer
Position # _______________ [Your Designation]
EMPLOYER CERTIFYING LEVEL III OR NDT SUPERVISOR
ALPHA NDT PTE LTD [Your Company]
Name: Name: [Your Level 3/NDT
Mr. John Kennedy [Your Manager] Mr. David Joseph Supervisor]
Title: Title:
General Manager [Manager Title] Technical Manager [Level 3 Title]
Relationship Relationship
to Applicant: Reporting Manager [Relation] to Applicant:
Company NDT Level III [Relation]
Dates Covered: Dates Covered:
01-Feb-2018 to Till Date[Experience] 01-Feb-2018 to Till Date [Experience]
E-mail: E-mail:
john@alphandt.com [Your Manager Email] david@alphandt.com [Your Level 3 Email]
Phone: Phone:
+91-22-6284995 [Your Manager Phone] +91-22-6284996 [Your Level 3 Phone]
ASNT ID (if applicable) ASNT ID (if applicable)
Not Applicable [Mention ID if have] 222634 [Level 3 ASNT ID]
Signature:
JOHN KENNEDY [Add Company Stamp] Signature:
David Joseph [Add Company/Level 3
Stamp] ALPHA NDT PTE LTD
ALPHA NDT PTE LTD
CUSTOMER CUSTOMER

Name: Name:

Title: Title:

Relationship Relationship
to Applicant: to Applicant:
Dates Covered: Dates Covered:

E-mail: E-mail:

Phone: Phone:

ASNT ID (if applicable) ASNT ID (if applicable)

Signature: Signature:

ASNT Level III Experience and Attestation Form 09 June 2020