Certification Application for the Certification of NDT Personnel

Certification Body for NDT-Personnel of TÜV Rheinland

Certification Application for the Certification of NDT Personnel

Acc. to DIN EN ISO 9712

E_ZA 9712_06_ 2016.docAs of: June 2016

A. Details of candidate / person to be certified

Name .......................................................................... ........................................................................ surname, first name title

Address .......................................................................... ........................................................................ street, number postcode, town

Date / place of birth ......................................................................... ........................................................................ email (business and/or private)

B. Details of employer (same as delivery and invoice address)

Company .......................................................................... ....................................................................... name department

Address .......................................................................... ........................................................................ street, number postcode, town

.......................................................................... ........................................................................ telephone, fax email * (contact person for further queries) C. Order number / billing address if different / in the case of non-German customers: tax ID number / miscellaneous ………………………………………………………………………………………………………………………………………………………………….

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D. Application for certification Types of application are:

Initial certification: Initial certification of a method Expansion of a method (by one level or sector) Extension of certification: Renewal - after approx. 5 years Recertification – after approx. 10 years

Type of certification

(initial, exp., new, recert)

Method/Level Sectors

(based on examination and documentary

evidence of NDT-activity)

For initial certification: no. of months

industrial NDT-experience

(see “Details”)

PED **

(Confirmed on sep. paper)

Certificate number at TÜV Rheinland

- if available -

The following documentary evidence is to be attached to the application or must be submitted to the CB:

Initial certification: Extension: - Confirmation of participation in NDT training - Doc. evidence cont. professional activity acc. to form - Documentary evidence of qualification examinations - Current photo by email to ISO9712@de.tuv.com - Current photo by email to ISO9712@de.tuv.com - In addition for recertification: - Documentary evidence of recertification examination

Please state in which language your ID card should be printed ** German English No ID Card

ID Card

* MANDATORY (This application will not be processed if no e-mail address is given!) ** referring to the cost: please also have a look here “Details of how to fill in the certification application

Certification Body for NDT-Personnel of TÜV Rheinland

Certification Application for the Certification of NDT Personnel

Acc. to DIN EN ISO 9712

E_ZA 9712_06_ 2016.docAs of: June 2016

E. Authorisation/sample signature: The signature authorisation is an obligatory requirement for issue of the DIN EN ISO 9712 ID card. With my signature I grant the Certification Body of TÜV Rheinland permission to scan my signature which is to be used solely for the DIN EN ISO 9712 ID card. Please sign in the following box:

F. Declaration of the employer, supervisor, authorised agent or self-employed person

I herewith confirm

that I am the employer, supervisor or authorised agent of the candidate to be certified

that as a self-employed person I assume the overall responsibility attributed to the employer acc. to Pts.. 5.5.4 and 5.5.3 of DIN EN ISO 9712

the correctness of the stated periods of industrial NDT-experience (for initial certification) that are required for certification

to meet the requirements and validity of the eye sight test acc., to DIN EN ISO 9712, pt. 7.4 or further spec. requirements

full and continuous documentation of the annual eye test acc. to DIN EN ISO 9712 for at least. one certification period

please fill in the date of last eye sight test (dd/mm/yy) ………………………………………………………………………..

in addition, for renewal or recertification, the continuous professional activity without significant periods of interruption (see form: Documentary evidence NDT-experience) acc. to Pts. 10.1.b and 3.27 of DIN EN ISO 9712

I herewith instruct the Certification Body to certify the candidate stated above and undertake to bear the costs incurred from certification provided that the costs are not included in the examination fees. Employer/supervisor/ ............................................................. ..................................................................................... authorised agent or self-employed person / Place, date Signature, company stamp Miscellaneous (please delete or add as applicable) .................................................................................... Name in clear writing G. Declaration of the candidate / person to be certified

I herewith affirm that all information I have provided is correct and true. I undertake to comply with and observe the professional ethical regulations for NDT-personnel (see Enclosure 1), as specified by the Certification Body for NDT-Personnel of TÜV Rheinland.

I acknowledge that

- the validity of the certificate is contingent on continuous activity and physical aptitude;

- significant periods where work activities are interrupted, e.g. a consecutive period >1 year, lead to the certificate becoming invalid;

- incorrect information, any abuse or misuse of the certificate or any violation of the professional ethical principles can lead to revocation of the certificate.

- I will inform the Certification Body immediately if information on the certificate is incorrect, if the requirements for certification are no longer complied with, if information relevant to certification, such as e.g. the address or employer, changes

- the certificate remains the property of the Certification Body and may be revoked when quoted in a misleading manner or used incorrectly.

- TÜV Rheinland do not assume any liability for damages that could result from my activities as a certified person. I agree that

- the certification issued be published in a list;

- my name, place of birth, date of birth and data relating to the certification issued be stored electronically;

- the Certification Body may obtain all information relating to the certification;

- the Certification Body be informed immediately of all objections to the certificate issued I indemnify the Certification Body from all claims that may result from improper or incorrect utilisation of the certificate. Candidate: ............................................................. ..................................................................................... Place, date Name, signature

Please send the application with all requisite documents to: If you have any questions about certification please contact:

Certification Body for NDT Personnel Susanne Nolting TÜV Rheinland Werkstoffprüfung GmbH Susanne Nolting Am Grauen Stein, D-51105 Köln : 0221 806 2470 or by email to: ISO9712@de.tuv.com : susanne.nolting@de.tuv.com

Certification body for NDT-Personal of TÜV Rheinland

Documentary Evidence NDT-Experience for

approval acc. to Pressure Equipment Directive

until 18.7.2016: 97/23/EC from 19.7.2016: 2014/68/EU

Attachment to certification request for certification of ndt-personnel acc. to DIN EN ISO 9712

E_Nachweis_PED.doc as per: June 2016

This sheet has to be shown when requesting initial certification or extension of certification.

Name and Prename of candidate: ................................................................................................................................

Certificate-No: ................................................................................................................................

We herewith confirm, that a.m. candidate collected sufficient experience on pressure equipment during the last 5 years. The confirming company is:

Pressure device manufacturer

Pressure device operator

Notified body ................................................................................. ……………........................................................................................... Name of company Place, Date representative, signature, company stamp

……………............................................................................................ Place, Date signature candidate

Please send this evidence together with certification request to:

Certification body of NDT-Personnel Susanne Nolting TÜV Rheinland Werkstoffprüfung GmbH Susanne Nolting Am Grauen Stein, D-51105 Köln : +49221 806 2470 mail to ISO9712@de.tuv.com : susanne.nolting@de.tuv.com

Certification Body for NDT Personnel of TÜV Rheinland

Documentary Evidence NDT-Experience

A) Industrial NDT experience for initial certification or B) Continuous professional activity for renewal or recertification Sufficient period of previous experience is prerequisite for admission to examination. It is added to the overall period of experience required for initial certification.

*1 Self-employed candidates require confirmation from the client in question E_Nachweis_Erfa.doc As of: June 2016

Surname and first name of the candidate: ...................................................................................... Employee Self-employed*1:

For A: Place and date of seminar: ...................................................................................... As applicable: certificate-no.: ................................. Please use a separate sheet for each method *** For B: Please refer (do not submit) to evidences covering the last full certification period (starting 2012)***

NDT-method / level/ sectors (MT; PT; VT; RT, RT-FI, UT, UT-WD) (c, f, w, wp, t)

Description of active ndt-work with regard to applied method (for B: please also see “Details of how to fill in the certification application”, section: extension of certification)

For A: - Period of accumulated experience - Total number of months For B: Date of document

For B: Name of document

Date and name (in clear writing) of employer or client, superior or supervisor, Signature, Address, company stamp, email address

Date and signature candidate: ..........................................................................

Ethical principles.doc As of: March 2016

Certification Body for NDT Personnel of TÜV Rheinland

Enclosure 1 to Certification Application for the Certification

of NDT Personnel in Accordance with DIN EN ISO 9712

EEtthhiiccaall PPrriinncciipplleess ffoorr NNDDTT PPeerrssoonnnneell Certificate holders must ensure that injury to persons or damage to the environment and property damage are avoided to the best of their knowledge and belief, and that the public interest is safeguarded. They must act in accordance with the latest level of technical standards and their conduct towards all other persons must be honest, incorrupt, loyal and impartial. Public Responsibility The holder of the certificate must safeguard and protect the interests and welfare of the general public during performance of his/her professional NDT activities. This means that he/she informs the responsible bodies, declines certain responsibilities or refuses tasks for which he/she is not qualified. Publications must be professionally, technically and objectively well-founded and only use content for which he/she is qualified by training and experience. He/she may not sign any documents if he/she does not fully understand or approve of the content. Relationship to Employer The contractual relationship to the employer must be regulated in such a manner that the professional ethical principles can be observed. Functions, competence and responsibilities must be clearly defined. Conflicts of Interest Certificate holders should endeavour to avoid conflicts. In such cases, however, where this is unavoidable, the corresponding partners are to be informed promptly and unreservedly about the reason for the conflict. All decisions, actions, assessments or judgements are to be made without any self-interest or personal benefit. Violation of Professional Ethical Regulations Any violation of professional ethical regulations leads to all certificates that have been issued for this person by the Certification Body for NDT Personnel of TÜV Rheinland losing their validity. In this case the certificate must be returned immediately to the Certification Body.