PSL/53 - BINDT

Certification Services DivisionNewton Building, St. George’s AvenueNorthampton, NN2 6JBUnited KingdomTel: +44(0)1604-893-811.Fax: +44(0)1604-893-868.E-mail: pcn@bindt.orgNON-DESTRUCTIVE TESTINGQUALIFICATIONApplication to purchase individual certificates of NDT qualification suitable for framingName and initials: ______________________________ PCN Number: _________Certificate number: _________________________Certificate number: _________________________Certificate number: _________________________Certificate number: _________________________Certificate number: _________________________Sub totalVAT @ 20% (UK orders only)Total enclosed(£29.00 + VAT)(£15.00+ VAT)(£15.00 + VAT)(£15.00 + VAT)(£15.00 + VAT)£ ______.____£ ______.____£ ______.____Please make cheques payable in Pounds Sterling to the British Institute of NDT.The address to which the certificates should be posted is as follows:Postal code:telephone:Email Address:Signature:date:The British Institute of Non-Destructive Testing is an accredited certification body offeringpersonnel and quality management systems assessment and certification against criteria setout in international and European standards through the PCN Certification Scheme.PSL/53 issue 17 1 st January 2014

PAYMENT SECTION:Method of payment (eithercredit/debit card or a cheque payableto BINDT):For payment by creditTick box ifchequeenclosed:Visa MasterCard Amex Switchcard (tick relevant box):Card number: Security code (last 3figures on the securitystrip on the reverse ofthe card)Card valid from (if aSwitch card, issuedate):Name on card:Card expiresend:Signature of abovenamed individual:Address of credit cardholder (if different fromthat in Part 1 of thisform):Please debit the above credit/debit card for theamount shown (applicants must enter the correctamount, which can be ascertained from documentPSL/35):£ : (including VAT)PSL/53 issue 17 dated 1 st January 2014

PCN USE ONLYINVOICE/FEE INFO: _________________________________________________SIGNATURE:________________________________________________________NAME: __________________________ POSITION: ________________________REMARKS:_____________________________________________________________________________________________________________________________ACTION COMPLETED DATE: _________________INITIALS:__________________This is not a certificate of competence. BINDT issues a separate traceable record of PCN certification forthis purpose.PSL/53 issue 17 1 st January 2014

Certification Services DivisionNewton Building, St. George’s AvenueNorthampton, NN2 6JBUnited KingdomTel: +44(0)1604-893-811.Fax: +44(0)1604-893-868.E-mail: pcn@bindt.orgNON-DESTRUCTIVE TESTINGQUALIFICATIONA N Other(PCN number ######)Qualified on date at Level # inNDT METHOD TESTING OFSPECIFIED PRODUCTSand has been awarded PCN certificatenumber #############Certificates similar to thisare available on qualityParche Marque paperdesigned for framing.If you require such certificates,please complete the orderform overleafConfirmed byFor and on behalf of theBritish Institute of NDTThis is not a certificate of competence. BINDT issues a separate traceable record of PCN certification forthis purpose.PSL/53 issue 17 1 st January 2014