PT. DUA UTAMA JAYA Jl. Yos Sudarso Complex Green Town Warehouse No.

1, Batam 29457, Indonesia Tel/Fax: +62-778-495120, +62-778-495121 REGISTRATION AND TERM & CONDITION PLEASE USE CAPITAL LETTERS

Name Sponsor Home Address Phone Type of Course
Training Requirements

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• • • • • • Personal CV (for Initial & Exam candidate). Copy of Result Notice for Retest & Re-initial Test Candidate. Enrollment Form (blank form attached). PT.DUJ Registration. Eye Test Cert. (Jaeger 1+Ishihara) for all kind of courses. 3 ea photo 4 X 6 size red background for 3.1, yellow for 3.2 & blue background for other Courses.

Details Registration Fee

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• Candidates should pay Registration Fee USD 85.00 for 3.0 & USD 165.00 for 3.1, 3.2, CSWIP, BGAS, PCN, IOSH, NEBOSH Courses. Any cancellation less than 1 week before commencement of course shall be charge 100% of Registration Fee*. • Make sure that name should be the same with your passport or ID Card, any request to change the name on your Certificate & ID Card shall be charge USD 25.00 per method. • In order to send certificates shall be charge USD 15.00 (ASEAN Country) & USD 35.00 for outside ASEAN. • Cancellation of Exam / Retest less than 1 week before commencement of exam shall be charge 20% from total Exam / Retest Fee. • Total Payment shall be settled 1 week before commencement of course*. • Payment Method by Cash or Transfer. We don’t accept Credit Card & Debit Card for the time being.

Our Account

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Account Name : PT. DUA UTAMA JAYA Bank : - Bank Mandiri, Batam Branch Jl. Imam Bonjol No. 1, Nagoya, Batam 29457, Indonesia IDR Account No : 109-000426703-5 USD Account No : 109-000-464618-8 Swift Code : BEIIIDJA • Our services are strictly limited to the training purposes, this training will include lunch (dinner), 2 times coffee break & training materials. Any other services not specified in this list shall be supplied by participants. • Details of Registration and this Term and Condition is exclusively for PT Dua Utama Jaya only. Should you need more details, please do not hesitate to contact us at: enquiry@ptduj.com or call us at : +62778495120, +627787239020.

Term & Condition

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Candidate Confirmation

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Signature & Company Stamp (if Company Sponsored)

(………………………………….) Name: ………………………….

Date: …………………….

E. WJS No. Bookings received without payment/order number will be treated as provisional which does not guarantee a place. please provide details of any adjustments you may i METHODS OF PAYMENT Full payment and/or Company Order no.Page 1 of 4 TWI enrolment form PLEASE SEND APPLICATION WITH YOUR PAYMENT AND THE NECESSARY ENCLOSURES TO: Please tick: Self . : …………………. ………………. Personal Information: TWI Candidate ID Number: (if taken other examinations with TWI) Course ref ____________ Course date ________________________ Course title _______________________________________________ _________________________________________________________ Full name as I/C or Passport _________________________________________________________ _________________________________________________________ Date of birth (dd/mm/yy) _____________________________________ Permanent private address _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Postcode ___________________ Car Registration No_____________ Private tel no ______________________________________________ E-mail ____________________________________________________ Correspondence address (if different from above) _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ Invoice Address (if different from below) _________________________________________________________ _________________________________________________________ _________________________________________________________ Sponsoring Company and Address _________________________________________________________ _________________________________________________________ __________________________ postcode ______________________ Contact name ______________________________________________ Telephone _________________________________________________ Fax ______________________________________________________ E-mail ____________________________________________________ Please tick if you are ο A member of The Welding & Joining Society ο An employee of an Industrial Member of TWI Do you have a disability or any special needs relevant to this course or examination? Yes ο No ο If yes.com PLEASE USE CAPITAL LETTERS THROUGHOUT WIM/WJS/TWI Industrial MEMBERS ONLY: To claim your discount (course fee only) please enters your Membership No: WIM Membership No. OR  Credit Card (Please Indicate if Company Card) YES NO Three digit security code _____________________________________________ Valid from & Expiry date ____________________________________________ Issue Number _____________________________________________________ Name (as it appears on card) _________________________________________________________________ House number and postcode of card holder: _________________________________________________________________ Signature of card holder _____________________________________________ OR  Company order no __________________________________________ Approving Manager’s name __________________________________________ Title _______________________________________________ SPONSOR’S SIGNATURE: Date: __________________________________________________ I would prefer an examination in week commencing (we will do our best to meet your requirements.  Cheque  Bank Draft  BACS made payable to : TWI Training & Certification (S. …………. 8.Asia) Sdn. If less than 14 days notice is given by you. Selangor.Asia) Sdn Bhd No. Jalan TSB 10 Sg. Malaysia Tel. TWI will ensure maximum possible notice is given to the attendees and reserves the right to substitute lecturers and modify the course details as required. TWI reserves the right to retain the whole fee. the event fee and the accommodation fee (if applicable) will be returned less a cancellation charge of 20%. TWI reserves the right to cancel the event in case of insufficient registration or illness of lecturers.E.: +603-61573528 / 7 /6 Fax.TRA05/EX07 Doc 1 Rev 16 . Bhd.. +603-61572378 E-mail: inquiry@twisea. In the event of cancellation by you.Indonesia Where did you hear about TWI Ltd? ο ο ο TWI Training website Bulletin / Connect BINDT Publications ο TWI Training newsletter ο NDT Cabin ο Other Internal Use Only Booking Ref: ________________ . Buloh. but reserve the right to offer alternatives) Venue: Kuala Lumpur Miri Others:  (please specify) Batam . Buloh Industrial Park 47000 Sg.Sponsored Company Sponsored TWI Training & Certification (S. must accompany this booking form. TWI Industrial No..

2.1 and 1.2U To be completed by all applicants applying to attend CSWIP Welding Inspection Examinations I confirm that I have read and comply with the pre examination entry requirements as laid down in the CSWIP Requirement Documents – DOCUMENT No.2.2.4U OGI Instructor ASCAN 3.2.Page 2 of 4 Examination Applied For (to be completed in full by all applicants) Examination Type: Initial.3U 3. renewal. Railway. .2 under qualified supervision. Wrought. Welds.2 Endorsement Concrete Supervisor 3. independently verified. Certified Visual Welding Inspector (Level 1) for a minimum of 2 years with job responsibilities in the areas listed in 1. supplementary.TRA05/EX07 Doc 1 Rev 16 . PCN.2. Welding Inspector (Level 2) Welding Inspector for a minimum of 3 years with experience related to the duties and responsibilities listed in Clause 1. AWS.  Please tick the appropriate box and give a detailed statement of how you meet the requirements. Welding Instructor or Welding Foreman/Supervisor for a minimum of 5 years.1 Level 3. this must be signed and verified by an employer/third party Visual Welding Inspector (Level 1) Although there is no specific experience requirement it is recommended that candidates possess a minimum of six months’ welding related engineering experience and two years industrial experience.2. CSWIP-WI-6-92.1U 3. ASNT. General Categories: Level 1 Welding Inspection (please circle) Underwater Inspection: (please circle) Please contact TWI for the relevant EX07 document Plastics: Please contact TWI for the relevant EX07 document CSWIP/AWS AWS/CSWIP PT RT Dig Rad ET PAUT RI UT VT BRS ACFM AUT TOFD Level 2 Level 3. bridging or retest of a previously failed examination Examination Body: CSWIP. 10th Edition January 2011 and understand that any fraudulent claim may result in the retraction of any certifications issued. BGAS PCN or BGAS Approval Number: Current CSWIP qualifications held: MT NDT Method (please circle) RPS LRUT Industry Sector: Aerospace.

2 Senior Welding Inspector certification plus three years documented experience related to the duties and responsibilities or an international equivalent. Welding QC Co-ordinator A current valid CSWIP 3. Please tick the appropriate box and give a detailed statement of how you meet requirements. CSWIP. this must be signed and verified by an employer/third party – Plant Inspection (Level 1) I hold current approved NDT Level 2 (ACCP.2.2.1 Welding Inspector or higher I hold ONC in Mechanical Engineering or equivalent . NDT Pre-certification experience Please list your specific experience and duration as required by the scheme documentation and attach copies of log book entries if available for NDT examinations. This experience must be verified by your employer or a recent major client: Verifier Name (in capitals): __________________________________________ Company: Position: Telephone no.TRA05/EX07 Doc 1 Rev 16 – Page 3 of 4 Senior Welding Inspector (Level 3) Certified Welding Inspector (Level 2) for a minimum of 2 years with job responsibilities in the areas listed in 1.3.: Email Address: Date: __________________________________________ __________________________________________ __________________________________________ __________________________________________ __________________________________________ Authenticated Company Stamp To be completed by all applicants applying to attend CSWIP Plant Inspection Examinations – I confirm that I have read and comply with the pre examination entry requirements as laid down in Section 3 of the CSWIP Requirements Documents – DOCUMENT No. 5 years' authenticated experience related to the duties and responsibilities listed in Clause 1. independently verified. this is not a pre-requisite for examination.3. or PCN) in two methods (BGAS Painting Inspector and CSWIP 3.1 Welding Inspector with 10 year’s documented experience related to the duties and responsibilities or an international equivalent. A current valid CSWIP 3.2.1 Welding Inspection qualifications are acceptable as methods) I hold CSWIP 3.2.1.2 and 1. 1. CSWIP-11-01 and understand that any fraudulent claim may result in the retraction of any certification issued. however certification will not be awarded until the experience is gained and evidence provided.

I understand that any appeal against an exam result must be received within six months of the exam date. You have the right of access to personal data that we hold about you. I have read the listing and include all the requested information. I have read and understood the documentation issued by the scheme management that is relevant to the examination for which I am applying and declare that I satisfy those criteria covering vision. I agree to read the Health & Safety and Security information provided by TWI and to abide by the guidance given. I understand that any false statement may result in the examination being invalidated. UK. products etc. The data may also be used to send separate unsolicited mailings containing details of events. Cambridge CB21 6AL. if applicable. or agents processing data on its behalf) will hold and use personal data supplied by me for administration purposes. I agree to abide by the requirements for certification as relevant to the examination for which I am applying. on payment of the access fee not exceeding £10. CANDIDATE’S SIGNATURE: .com). assessed and authenticated industry experience in this field (Mature Entry Route). a verified CV can be supplied – Must be authenticated by Line Manager _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ Plant Inspections (Level 2) I I hold a valid Level 1 Plant Inspection approval I have successfully completed the level 1 exams as a pre entry requirement _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________________________________________ To the best of my belief. You have the right to ask TWI Ltd NOT to send such mailings. If you do not wish to receive this information from TWI Ltd.TRA05/EX07 Doc 1 Rev 16 – Page 4 of 4 I have a minimum of Five years. with the CSWIP rules on use and misuse of certificates and on professional conduct (see www. TWI Ltd.PLEASE NOTE I understand that TWI Ltd and its associated trading companies (and companies. the candidate’s statement given above is correct at the time of signing. These purposes have been notified under the Data Protection Act 1998. Requests should be addressed to The Data Controller. Granta Park. new services. I accept responsibility for any examination fees in the event of non-payment by the sponsor. please tick this box . organisations. Verifying signature (employer or equivalent): CANDIDATE . In particular I agree to comply. Gt Abington. training and experience.cswip. I understand that occasionally images of training and examinations are taken by TWI for publicity and other purposes and that permission for my inclusion in such material is implied unless I make it known to Customer Services at registration that I do not wish to feature.

no need to be specific. 3) of examination you require. nomor telpon /email dan tanggal penandatanganan. Step 2 Page 2 requires you to indicate what scheme (PCN.INSTRUCTIONS In order to facilitate the course/examination form. hal-hal yang perlu diisi adalah : nama lengkap sesuai paspor. nama & alamat perusahaan serta contact persons yang bertanggung jawab (bila disponsori oleh perusahaan) mohon ditulis dengan huruf capital/besar. CSWIP atau BGAS). retest. If you are taking Lev 2 (Welding Inspector). maka Anda memerlukan tandatangan pihak ketiga (atasan. supervisor. and also add in some information on the duties that you do briefly only. nama perusahaan. Pada metode pembayaran. 2. Contoh. DOB & both addresses (one permanent address & the other is the correspondence address) in capital letters. sertakan juga nama lengkap penandatangan (perusahaan/pihak ketiga). rekan kerja). centang dan tuliskan pengalaman kerja secara singkat pada kotak yang relevan dengan Anda. Step 1 Please be reminded that the page 1 (front page) requires. Step 3 The final & most crucial part of this form is to get the VERIFICATION SIGNATURE FROM YOUR COMPANY IF SPONSORED BY THE COMPANY. . understand them & please sign them at the bottom box indicated below the form. mohon pastikan Anda sudah membaca formulir ini secara menyeluruh. jabatan. 2. Terakhir. CSWIP OR ACCP. Langkah 2 Di halaman 2. Bila Anda self-sponsored. renewal. IF SELF-SPONSORED THAN YOU REQUIRE TO GET A THIRD PARTY TO SIGN AT THE BOX JUST BELOW THE NDT PRE-CERTIFICATION EXPERIENCE. Kemudian pada bagian bawah. memahami persyaratan dan mengisinya dengan lengkap. etc). serta cap perusahaan (pada kotak Authenticated Company Stamp). etc). silakan tandatangan di bagian bawah untuk menunjukkan bahwa Anda atau perusahaan bertanggung jawab untuk pembayaran. Jika Anda mengambil Level 2 (Welding Inspector). welds. metode ujian yang Anda ikuti (initial. silahkan centang pada kotak yang sesuai dengan pengalaman kerja Anda. mengharuskan Anda untuk menuliskan jenis sertifikasi (PCN. Silahkan bubuhkan tandatangan tersebut pada kotak di bawah bagian NDT Pre-certification experiences. as you scroll thru the same page below are the experience required by ticking the relevant boxes: Example. if sponsored by the company than also put in the company names & full address in capital letter. understood the requirement & dully fill in the forms. PLEASE INDICATE THE TICK BOX IN WHICH PART YOU BELONG TO OR WHICH PART TELLS YOU THE EXPERIENCE LEVEL THAT YOU HAVE. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------PETUNJUK PENGISIAN FORMULIR Untuk memfasilitasi pengisian formulir ini. Kemudian tambahkan beberapa informasi tentang tugas-tugas yang Anda lakukan secara singkat. etc) method of exams you are taking & level (Lev 1. Please fill in the company name with the company stamp on the right box where it says Authenticated Company Stamp Final part is that you (candidate) need to read the statement below. Langkah 3 Langkah yang paling penting dari formulir ini adalah untuk mendapatkan tandatangan dan verifikasi dari perusahaan yang mensponsori Anda. Langkah 1 Di halaman 1. wrought. silahkan Anda membaca dan memahami penyataan di bagian bawah formulir dan bubuhkan tandatangan Anda pada kotak paling bawah. please ensure that the forms are completely read. name in full as per passport. tanggal lahir & alamat (alamat permanen & alamat korespondensi). tidak harus spesifik. tingkat/level ujian (1. please sign at the bottom to indicate that you or the company is responsible for the payment. 3) serta sektor industri dimana Anda bekerja (aerospace. On the method of payment.

TWI Certification Ltd. SEM/CSWIP/S511F/10.04 . Name : Sheet No : Date : Near Distance Test : Colour Vision Test : Name of qualified oculist or optometrist : Address : Signature : Stamp of oculist / optometrist Date : Near Distance Test : Colour Vision Test : Name of qualified oculist or optometrist : Address : Signature : Stamp of oculist / optometrist © 2006.Certification Scheme for Welding and Inspection Personnel CSWIP EYESIGHT TEST Some CSWIP certificates are only valid provided the holder’s eyesight is regularly tested and shown to meet the published minimum requirements.

2 (yellow background) 3.2 5 days 07 . PSL 30.dujtraining.09 14 .CSWIP Course & Examination 492 for 1 or 2 Catgr + 80 PCN Levy 278 per Catgr + 80 PCN Levy 553 for 3 or 4 Catgr + 80 PCN Levy 368 for 1 or 2 catgr.06 20 .2.300 559 1. 172 per Catgr.21 05 .23 Senior WI 3.1: Above 3 Years as QC Inspector or 2 Years that have Cert.117 1.02 3.0 (blue background) CSWIP 3. Fill in TWI Exam Form (PCN Form: PSL 57 B) 4.1 (red background) CSWIP 3. Photograph size: 4x6 (3 pcs) CSWIP 3. INITIAL RETEST ONLY 1.09 2.23 19 . CSWIP 3. Copy of Results Notice Paper and refresher attendance cert 2. Copy of Results Notice Paper 2. Fill in Course & Exam Form 6.09 17 . CV 2. 1.1 (red background) CSWIP 3.1 (Mandatory) + CSWIP RI 3.9 1.21 19 . Copy of Exam Report (For CSWIP-BGAS Painting Inspector) 3.17 12 .02 732 258 512 + 80 PCN Levy Magnetic Testing Level II 5 days 18 . Bengkong Batam 29432.22 825 361 1.19 04 . Photograph size: 4 x 6 (3 pcs) CSWIP 3. PCN and BGAS (blue background) 4.009 1. CV (Personal CV+TWI Anrollment Form) 3.167 + 80 PCN Levy 722 + 80 PCN Levy 4.25 28 .375 Exam (Initial) 258 516 Course+Exam 688 1.19 05 .25 06 . CV (Personal CV+TWI Enrollment Form) 2.953 B.1 (red background) CSWIP 3.12 14 .0: Above 6 Month QC Inspector or Candidates are expected to have an engineering background CSWIP 3.0 Welding Inspector 3.031 364 364 708 + 80 PCN Levy 559 597 597 488 + 80 PCN Levy 294 Per Week ( All Grade ) 268 268 358 + 80 PCN Levy 175 - 8 9 BGAS-CSWIP BGAS-CSWIP PCN Painting Inspector Grand 3/2 Site Coating Inspector 10 CSWIP ( 1 & 2 category) 708 + 80 PCN Levy 1.07 07 .713 1367+ 80 PCN Levy 1. Administration / Booking = 20% x Course / Exam Fees Should held minimum experiences in welding field Inspection as below: CSWIP 3. Eye Test Report (Jaeger 1 + Ishihara) 5. Original Certificate + ID Card 3.250 550 ( 1 & 2 category) 533 + 80 PCN Levy 1.16 3. Dua Utama Jaya Jl. Certification 1 2 CSWIP CSWIP Training Visual WI 3.05 5 days Feb Mar Apr May June July Augst Sept Oct Nov Dec Course Only 516 1.16 12 .27 07 .2. Eye Test Report (Jaeger 1 + Ishihara) 6.12 21 .com COURSE & EXAM PRICE YEAR 2011 TYPE OF COURSE NO. RETEST ONLY 1.0 (blue background) CSWIP 3.23 04 .2 (yellow background) 5. 373 + 80 PCN Levy 120 392 + 80 PCN Levy 199 392 + 80 PCN Levy 199 413 + 80 PCN Levy 313 413 + 80 PCN Levy 313 ( Retest ( Retest 493 + 80 PCN Levy 392 + 80 PCN Levy 189 ) ( Initial 189 ) 392 + 80 PCN Levy 189 ) ( Initial 189 ) 777 + 80 PCN Levy 1. CSWIP 3. Administration / Booking = 20% x Course / Exam Fees D. PSL 30. PSL 44) 4.Week 1 5 days 3 days 3 days 5 days 5 days 5 days 5 days 03 .063 688 1.4 (PCN Lvl II) If Any NDT Appreciation: Welders / Fitters.228 722 + 80 PCN Levy 4.498 625 3.0 (blue background) CSWIP 3.332 + 80 PCN Levy Phase Array Level II 15 days 14 .18 28 .11 21 .719 Re. Yos Sudarso Complex Green Town Warehouse No.22 17 . PSL 44) 6.14 19 .com / enquiry@ptduj.167 + 80 PCN Levy 891 1.682 777 + 80 PCN Levy 550 ( 1 & 2 category) 619 533 + 80 PCN Levy 258 512 + 80 PCN Levy 361 512 + 80 PCN Levy 361 722 + 80 PCN Levy 625 722 + 80 PCN Levy 625 Ultrasonic Testing Lvl II ( W ) 10 days 14 . Photograph size: 4 x 6 (3 pcs) CSWIP 3. Eye Test Report (Jaeger 1 + Ishihara) 5.2: Above 2 Years as QC Inspector + Held Cert.718 447 415 498 490 559 2.07 17 .805 602 Interpreter Only 172 - 4 5 6 CSWIP CSWIP CSWIP/NDT Welding QC Co-ordinator Bridging AWS to CSWIP NDT Appreciation Plant Insp Level 1 . Administration / Booking = 20% x Course / Exam Fees Pre-reuisite for Candidate who will attend TWI .1 3 CSWIP Senior WI 3.PT. Administration / Booking = 20% x Course / Exam Fees C.2 (yellow background) 5.2 with RI 602 1.0 or 5 Years as Welding Instructor / Welding Forman CSWIP 3.20 08 . +62-778-7239021 E-mail: du_jaya@yahoo.375 1.2. Fill in Course & Exam Form (if PCN Form: PSL 57A. Engineer Background Site coating Inspector: Above 6 Month + QC Paint or Coating.610 1. Photograph size: 4x6 (3 pcs) CSWIP 3.Initial (Exam) 258 516 Retest 129 275 5 Yr Renewal-Certificate ' ( Retest 172 ) ( Initial 10 Yr Re-Certification 278 ) YEAR 2011 NETT P R I C E ( USD ) 07 . RENEWAL(5 YEARS) / RE-CERTIFICATION (10 YEARS) 1.29 10 . +62 778 495121 HP: +62 811 697 001 .CSWIP/PCN Level II Personel Certification Candidates sould have NDT Level I and II ASNT TC 1A Certificate Note: If there is any cancellation by candidate. less than 1 (one) week from the date of schedule.168 597 597 488 + 80 PCN Levy Radiographic Interpreter 3.Week 2 24 .16 1.22 1.0 (blue background) CSWIP 3.12 18 .1 Duration Jan 3 days 03 . 454 for 3 or 4 Catgr.762 + 80 PCN Levy PCN ( 3 & 4 categories) 11 CSWIP 619 ( 3 & 4 categories) PCN 12 CSWIP PCN 13 CSWIP PCN 14 CSWIP PCN 15 CSWIP PCN 16 CSWIP PRE-REQUISITE DOCUMENT FOR BOOKING CANDIDATES A.2.10 02 .21 1.19 21 .22 825 361 512 + 80 PCN Levy Penetrant Testing Level II 5 days 11 .28 05 .06 TBA 17 .08 18 .375 1. CSWIP WI Log Book (Track Record of Experiences 4 Year) 6. Engineer Background NDT .4 7 days 03 .375 3.719 516 Writen and/or Practical 294 ( Retest 193 ) ( Initial 323 ) 3.24 25 .825 + 80 PCN Levy 1.com www.256 498 490 559 258 273 - - 392 + 80 PCN Levy ( Retest 248 ) ( Initial 248 ) 7 CSWIP Plant Insp Level 1 . Fill in TWI Exam Form (PCN Form: PSL 57 B. will be charged 20% from the total course fee / exam fee .009 1.1 (red background) CSWIP 3.25 19 .056 + 80 PCN Levy TOFD Level II 10 days 05 .11 11 .265 + 80 PCN Levy Ultrasonic Testing Lvl II ( TM ) 5 days 14 .2 (yellow background) 4. Supervisor and Manager Level Plant Inspector: Above 5 Years and held Multi Certificates of Discipline Inspection Painting inspector: Above 6 Month + QC Inspector.21 21 . Foreman.16 25 . Indonesia Tel/Fax: +62 778 495120.620 1.1 without RI 516 1.710 625 4. COURSE AND INITIAL EXAM 1.11 13 .

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