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

:
:
:
:
:

Email : ...
Date :

Training
Requirements

Details
Registration Fee

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*.

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.

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 dont accept Credit Card & Debit Card for the
time being.
Our Account

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

Term &
Condition

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.

Candidate
Confirmation

Signature & Company Stamp (if Company Sponsored)

(.)
Name: .

Date: .

TRA05/EX07 Doc 1 Rev 16 - Page 1 of 4

TWI enrolment form

PLEASE SEND APPLICATION WITH YOUR PAYMENT AND THE
NECESSARY ENCLOSURES TO:

TWI Training & Certification (S.E.Asia) Sdn Bhd

No. 8, Jalan TSB 10 Sg. Buloh Industrial Park
47000 Sg. Buloh, Selangor, Malaysia
Tel.: +603-61573528 / 7 /6
Fax. +603-61572378
E-mail: inquiry@twisea.com
PLEASE USE CAPITAL LETTERS THROUGHOUT

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

Please tick:
Self - Sponsored

Company Sponsored

WIM/WJS/TWI Industrial MEMBERS ONLY:

To claim your discount (course fee only) please enters your
Membership No:
WIM Membership No. : ..

TWI Industrial No. . WJS No. ..

In the event of cancellation by you, the event fee and the accommodation fee
(if applicable) will be returned less a cancellation charge of 20%. If less than
14 days notice is given by you, TWI reserves the right to retain the whole fee.
TWI reserves the right to cancel the event in case of insufficient registration
or illness of lecturers. 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.

METHODS OF PAYMENT

_________________________________________________________

Full payment and/or Company Order no. must accompany this booking form.
Bookings received without payment/order number will be treated as provisional
which does not guarantee a place.

_________________________________________________________

Cheque
Bank Draft
BACS
made payable to : TWI Training & Certification (S.E.Asia) Sdn. Bhd.

Date of birth (dd/mm/yy) _____________________________________

Permanent private address

OR Credit Card (Please Indicate if Company Card) YES NO

_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________
Postcode ___________________ Car Registration No_____________

Three digit security code _____________________________________________

Valid from & Expiry date ____________________________________________
Issue Number _____________________________________________________
Name (as it appears on card)

Private tel no ______________________________________________

_________________________________________________________________

E-mail ____________________________________________________

House number and postcode of card holder:

Correspondence address (if different from above)

_________________________________________________________
_________________________________________________________
_________________________________________________________
_________________________________________________________

_________________________________________________________________
Signature of card holder _____________________________________________
OR Company order no __________________________________________
Approving Managers name __________________________________________

Title _______________________________________________

Invoice Address (if different from below)

SPONSORS SIGNATURE:

_________________________________________________________
_________________________________________________________

Date:

_________________________________________________________

I would prefer an examination in week commencing

__________________________________________________

Sponsoring Company and Address

_________________________________________________________
_________________________________________________________
__________________________ postcode ______________________
Contact name ______________________________________________

(we will do our best to meet your requirements, but reserve the right to
offer alternatives)

Venue:
Kuala Lumpur

Miri

Telephone _________________________________________________

Others: (please specify) Batam - Indonesia

Fax ______________________________________________________

Where did you hear about TWI Ltd?

E-mail ____________________________________________________
Please tick if you are
A member of The Welding & Joining Society
An employee of an Industrial Member of TWI
Do you have a disability or any special needs relevant to this
course or examination?
Yes
No
If yes, please provide details of any adjustments you may
i

TWI Training website

Bulletin / Connect
BINDT Publications

TWI Training newsletter

NDT Cabin
Other

Internal Use Only

Booking Ref: ________________

TRA05/EX07 Doc 1 Rev 16 - Page 2 of 4

Examination Applied For (to be completed in full by all applicants)

Examination Type: Initial, supplementary, renewal,
bridging or retest of a previously failed examination
Examination Body: CSWIP, PCN, AWS, ASNT, BGAS
PCN or BGAS Approval Number:
Current CSWIP qualifications held:
MT

PT

RT

ET

RI

UT

VT

BRS

NDT Method (please circle)

RPS LRUT

Dig Rad

Level 1

Level 2

PAUT

AUT

TOFD

ACFM

Industry Sector: Aerospace, Welds, Wrought, Railway,

General
Categories:
Welding Inspection (please circle)

Supervisor

AWS/CSWIP

Underwater Inspection: (please circle)

Please contact TWI for the relevant EX07 document

Level 3.2.1

Level 3.2.2

CSWIP/AWS

3.1U

3.2U

3.3U

3.4U

Instructor
OGI

ASCAN

Endorsement
Concrete

Plastics:
Please contact TWI for the relevant EX07 document

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. CSWIP-WI-6-92, 10th Edition January 2011 and understand that any fraudulent claim may result in the retraction of any
certifications issued.
Please tick the appropriate box and give a detailed statement of how you meet the requirements, 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.

Welding Inspector (Level 2)

Welding Inspector for a minimum of 3 years with experience related to the duties and
responsibilities listed in Clause 1.2.2 under qualified supervision, independently verified.
Certified Visual Welding Inspector (Level 1) for a minimum of 2 years with job responsibilities in the areas listed in 1.2.1 and 1.2.2.
Welding Instructor or Welding Foreman/Supervisor for a minimum of 5 years.

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 1.2.1, 1.2.2 and 1.2.3.
5 years' authenticated experience related to the duties and responsibilities listed in Clause 1.2.3,
independently verified.

Welding QC Co-ordinator
A current valid CSWIP 3.2 Senior Welding Inspector certification plus three years documented experience related to the duties and
responsibilities or an international equivalent.
A current valid CSWIP 3.1 Welding Inspector with 10 years documented experience related to the duties and responsibilities or an
international 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 is not a pre-requisite for examination, however certification will not be awarded until the experience is gained and
evidence provided. This experience must be verified by your employer or a recent major client:

Verifier
Name (in capitals): __________________________________________
Company:

__________________________________________

Position:

__________________________________________

Telephone no.:

__________________________________________

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. CSWIP-11-01 and understand that any fraudulent claim may result in the
retraction of any certification issued.
Please tick the appropriate box and give a detailed statement of how you meet requirements, this must be signed and verified
by an employer/third party
Plant Inspection (Level 1)
I hold current approved NDT Level 2 (ACCP, CSWIP, or PCN) in two methods
(BGAS Painting Inspector and CSWIP 3.1 Welding Inspection qualifications are acceptable as methods)
I hold CSWIP 3.1 Welding Inspector or higher
I hold ONC in Mechanical Engineering or equivalent

TRA05/EX07 Doc 1 Rev 16 Page 4 of 4

I have a minimum of Five years, 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, the candidates statement given above is correct at the time of signing.
Verifying signature (employer or equivalent):
CANDIDATE - PLEASE NOTE
I understand that TWI Ltd and its associated trading companies (and companies, organisations, or agents processing data on its behalf) will hold and use
personal data supplied by me for administration purposes. These purposes have been notified under the Data Protection Act 1998. The data may also be used
to send separate unsolicited mailings containing details of events, new services, products etc.
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, please tick this box . You have
the right of access to personal data that we hold about you, on payment of the access fee not exceeding 10. Requests should be addressed to The Data
Controller, TWI Ltd, Granta Park, Gt Abington, Cambridge CB21 6AL, UK.
I agree to read the Health & Safety and Security information provided by TWI and to abide by the guidance given.
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.
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, training and experience. I accept responsibility for any examination fees in the event of non-payment by the sponsor. I
agree to abide by the requirements for certification as relevant to the examination for which I am applying. In particular I agree to comply, if applicable, with
the CSWIP rules on use and misuse of certificates and on professional conduct (see www.cswip.com).
I understand that any appeal against an exam result must be received within six months of the exam date.
I have read the listing and include all the requested information.
I understand that any false statement may result in the examination being invalidated.

CANDIDATES SIGNATURE:

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

Certification Scheme for Welding and Inspection Personnel

CSWIP
EYESIGHT TEST
Some CSWIP certificates are only valid provided the holders eyesight is regularly tested and
shown to meet the published minimum requirements.

Name :

Sheet No :

Date :
Near Distance Test :
Colour Vision Test :
Name of qualified oculist or optometrist :
Address :

Stamp of
oculist / optometrist

Signature :

Date :
Near Distance Test :
Colour Vision Test :
Name of qualified oculist or optometrist :
Address :

Stamp of
oculist / optometrist

Signature :

2006, TWI Certification Ltd.

SEM/CSWIP/S511F/10.04