Where marks from earlier examinations are to be included in the weighted composite grade, the candidate should supply the relevant examination result notice (or, where unavailable, verifiable information from ‘which the date and scope of the examination and the PCN Test Centre where the examination took place can be ascertained). Failure to comply with this requirement may result in a refusal to examine. ‘Applications shall only be completed by the candidate seeking PCN certification. If uncertain of the requirements for this application, please consult the Test Centre or PCN before proceeding. PCN INTRODUCES EL! PCN is transitioning to e-certification, whereby certificates are to be issued electronically, so that PCN certificate holders can view and print their certificates from their laptop or mobile device. To be eligible for e-certification, the PCN holder must ensure PCN has an up-to-date electronic copy of their photo (taken within the past 10 years), a signature and valid email address. APPLICATION FORM PART 1. CANDIDATE'S PERSONAL DETAILS ~ ALL PARTS ARE MANDATORY Family CHELLAPPAN- A ZELVIN- © Given names: Candidate's usual residence, including postcode/zip code (this address willbe shown on the certificate): NO;7/t08B Asivvatha Valiya vilai , kumayYapuram(P-0) kawign kumatti Tani! Nadu, India Pin- 684t6h Personal email address (or issue of e-certificata): Solvinkdopt@gmai!. com ‘Address, including postcode/zip code, to which the PCN certificate, when issued, isto be sent (if hardcopy certificate issued). | CANDIDATE'S SIGNATURE ‘AUTHORISING CERTIFICATE TO 8€ SENT TO ABOVE ADDRESS: i | Telephone number including area PCN number: | ccode/international dial code: +91 AYA 36QR002 Gender (optional): | Date of birth Male. |{slmmivnn: 02-08-1943 this fact to the attention ofthe examining body. ‘PART 2. CURRENT EMPLOYMENT DETAILS. Candidate's postion in the organisation: NIT TECHNICIAN Ttmay be possible to make provsion in PCN examination or canaidtes with spell requirement please ting — | Employer's name and address (including telephone number, email address and post code) Employment status (employed or self employed): EMP/OYED ‘The Brish ste of Non Destructive Testing san accredited certncauon body cffrng personnel an qualty management systems sssessmen and cerfision agit rts tout in ntemaionl and European eterdatds vaugh the PEN Carifton Scher {© 2022 he wrsh stu of Nom Destructive Testing lights Reserved Tis documents protected by UX and international copyrightlaws and remains the nteectual property of BINOT. Reprocurton and tribton ofthe docament without ne writen pation of BIMDT istrict prt PSLS7A Issue 18 dated 1" January 2022PART 3. PRE-CERTIFICATION TRAINING [Attach evidence of satisfactory completion of PCN approved training course or provide the following details for classroom training: Name of training organisationand |(yQ@LE QUALITY EVALUATION PRIVATE LIMITED, | ttle/reterence of relevant training course: TRICHY: PCN LEVEL -2 RI INITIBL DENSE (Weng) Dates of course (from/to): “Ths documents protected by Uk and international copyright laws andremalns thence! pepecyof BINT. ‘Te Bish sue of Non Destructive Testing an accredod certification body fring persone! and guaty management ystems assessment and cereficaton againat ceria zt out minternational and European standards through the PCN Certitiation Scheme Y) at {©2022 The Bish institute of Non-Destructive Testing Al RightsReserved. . Reproduction end dstibation ofthe document that the written perrsion of INDT iit prbvted PSL S7AIssue 18, Page 4 of 10 dated 1" January 2022PART 4. EXAMINATION APPLIED FOR (must be completed - check availability with the Test Centre before completing) | Products or industry sector in which certification is sought (castings, welds, forgings/wrought products, pre & ine service inspection, railway or aerospace): WELDS [NOT method 7 MT 7 " (O [ew (tek only ONE NOT method): | | 1 rr TorD | paut | Other pease state: Tava (ek one Bead 7 oO 1: note: Ris evel only | l ‘level 3, state which exam part(s); ‘Sector/methods applicable to PED recognition and administration charge _ 2s ant eon 20 Edy Current 2 Magnetic article Testing 22 Liquid Penetrant Testing 23 Val testing 2a.Utrasonic Testing 25 Radiography nro 2B Phased Aray | 2a Computer achgrapie Testing > lographic Interpreter Taciaton ste (ek ony one Box and | Basic radtion seety Taian roteon apeniaor lenore sector, NOT method, level and categories) State in the space below the categories of certification that you seek to attain (see relevant appendix to PCN/GEN}. Note that there may be limitations upon the number of categories that may be attempted at any one sitting - consult PCN or the Test Centre for further advice. PCN LEVEL -2 RI INITIAL DENSE Mere, | Preferred examination date and —— N@E,TRIC AY PART 5. PRE-CERTIFICATION EXPERIENCE {Experience s not an essential pre-requisite for level 1 and 2 examinations only. However, i such evidence is available at the time of examination, and tis a mandatory requirement that this be provided direct tothe AGB on the PSL 30 Attached, The Bish tt of Non Destructive Testing anaceredted eration body ering personnel and quality maragement systems secsmert and ceeation aginst itera eto ininteratena and European stndaras tough te PCN Cereaton Sehene (© 2022 The Bish institute of Nor-Desu ute Testing Al Reis Reserved. ie Thisdocuments protected by UK and international copyright laws and reais the inlets property of NDT, UKAS | Reproduction and astrbuton ofthe document without The written peieson of IND istrict probed See cy PSL S7A issue 18 Page Sof 10, dated 1" January 2022Industrial NDT Experience ~ the experience needed to acquire the skill and knowledge to fulfil the provisions of {qualification in the eppropriate sector, and which is gained under the supervision of Appropriately Qualified Personnel, Jn the application of the NDT method In the sector concerned, Qualified supervision ~ supervision of candidates gaining experience by NDT personnel certificated under the PCN Scheme or by non-certificated personnel who, in the opinion of BINDT, possess the knowledge, ski, training and ‘experience required to properly perform such supervision. ‘Appropriately Qualified Personnel — individuals carrying out supervision of candidates for PCN certification holding, relevant certification issued by a BINDT recognised certification body meeting the requirements of ISO/IEC 17024. NOTE: The Supervisors certificate(s) must be verified as the same level, sector and method and must be valid at the time the experience was gained. This may include certification schemes other than iSO 9712, such as EN 4179 and SNT-TC-1A providing that this certification has ben gained using external training/examination support provided by a BINDT approved organisation ‘The organisation must be a BINDT approved ATO, AQB and/or OA status. Please contact n@bindtomg if clarification on thisis required. Experience may be gained flowing lve 1 and 2 examinations ony and recorded on Form PS/30. Once evidence of experience satisfying the above definitions has been accumulated, it is provided direct to PCN, together with an. apiication for certfcation ug frm PSU/S7C. Level candidetes~qust have the required amount of NOT txperence prior to taing any examination. [[caimed duration of experience in applying the NOT method under qualfied | ] | supervision enter aumber of months or weeks) | SL 30 to be completes wth deta | Name, address and telephone number or email address of person who can [verify experience claimed: PART 7. CANDIDATE'S STATEMENT CONFIRMING ELIGIBILITY FOR EXAMINATION onan el. 2.€... ‘CANDIDATE'S FULL NAME: PCN NUMBER (if existing PCN certificate holder): ' have read and understand PCN General Requirements for the certification of personnel engaged in NOT, particularly the criteria for eligibility, and hereby confirm that | satisfy those criteria covering vision, training and experience applicable to the level and NDT method for which | arm seeking certification. n the event that! should be awarded PCN certification. | agree to comply with the PCN Code of Ethics (published as PCN document €P27). | understand that, in the event of a false statement being discovered, any certification awarded as a result of the examination will be null and void. | accept responsibilty for payment of examination fees in the event of non-payment by the sponsor. SIGNATURE: oave: 13-02-2022 Attach |. _ Evidence of vision test (PCN PSL/44 may be used) unless vision test arranged at Test Centre b. Evidence of training Evidence of experience {PCN document PSt/30) . Correct examination fee (unless part 6 of this form is appropriately completed); details of fees are available from the test or examination centre. Bring . Your PCN record of certification ‘he ertsh sutute of Non Destructive Testing san sceredtedcartcaton body tering persone! and quit management systems ‘is cocument is rotated by UK and inteertina copyright aw: an remain the ntelectsl property of NDT. Aeprodiction and distribution ofthe document without the written permission a SINDT istry prohtes PSL STA Issue 18 Page 6 of 10 dated 1" January 20224. Your own NOT instrument if desired (information on acceptable Instruments is available from the Test Centre), together with a valid calibration certificate. PART 8. VERIFICATION OF CANDIDATE'S STATEMENT BY THE SPONSOR, EMPLOYER OR, IF THE CANDIDATE IS SELF- EMPLOYED, A REFEREE. ‘To the best of my bellef, the candidate's statement given aboveis correct atthe time of signing. ‘The Brtih nate of Non Destructive Testing san accredited corfication body offering personel and quality management ystems resent and craton against eters stout imitations na European tances trough te PON Certain Severe, {© 2022 Te Btn iste of Non Destructive Testing. All Nights Reserved. This documents protected by UK and international copyright laws and remain the inliactual property of INDT. Reproduction and ctibution of the document thou theriten permision cf BINDT i stipend PSL STA Issue 18 cs Page 7 of 10 dated 1" January 2022PART 9, FOR OPTIONAL USE BY THE TEST CENTRE EXAMINATION DATE EXAMINATION VENUE: EXAMINE 5 MODERATOR: PAYMENT RECEIVED: on RESULT REFERENCE: EXAMINATION FILE COMPLETE AND CLOSED (intials/dat REMARKS (If any verification sought and obtained, record details below or on.a separate page and keep with candidate ‘exam pack) GENERAL DATA PROTECTION REGULATION (GDPR) - INOT will store and use the information given on this form only for the purpose for which it has heen pravided. Your personal detalls and any other data you provide to BINDT will not be passed on to a third-party without your permission. BBINDT would like to contact you from time to time to let you know about its other services that may be of interest, such a special offers and discounts, events and new products. f you are happy to be contacted by BINDT, please indicate by ing the box below: [EJ 14™ Happy For sinot 10 CONTACT ME WITH INFORMATION THAT MAY BE OF INTEREST You can subscribe or unsubscribe at any time, simply let us know. ‘The frtish nstute of Non-Destructive Testingisan accredited certification body offering personnel and quality management sytem: sserament and cerfcaion aginst era ato international ard European standards trough the PEN CertedonSeneme. {© 2022 The Bish nit of Non Destrctive Testing Al RightsReserved ‘Ths document protected by UK and ineratina copyright laws and remains the intellectual property of INDT. ‘eprotcton and triton ofthe document without he wten permission oFINDT istic rote PSLS7A Issue 18, Page 8 of 10 dated 1" January 2022PART 6. PAYMENT (complete applicable sections only) | Name and address for invoice (if different from candidate's), including telephone /fax number SELVIN-c NO: 7088 _Asirvatha Nagay, valiya vilai kumarapuras (P-0), Kaniya kwmari, | Tamil wade, inchic, maeeaien ‘Some Test Centres provide accommodation or information on the availability of local ‘accommodation. f you wish to receive assistance wth accommodation, please tk here: Preterred method of payment (oank Tick bor cheque | erat Acs, cheque, ret car enclosed: | Name of senior responsible official ofthe orgenisation paying ‘examination fees (not the candidate ~ unless self employed Company order reference: For creditcard payment, tick | Visa | MasterCard the relevant box and provide ‘Amex | Switch | iesue a expiry dates: issue and expiry dates: = ‘Name on card: | (Card number: ‘Security code (last 3 figures fn the security strip on the reverse of the card) _ Signature of above named individual cs 2 ‘Address of creditcard holder: Debit the above credit/debit card for the amount shown in respect of examfees | £ {check with Test Centre to confirm that credit card payment is available) ‘The frit nsette of Non-Destructive Testing san accredited certification body offer sonnel and qulty management sytom= Tremere gn chap onigceenenrers oaaseerncomatasace” FA) 1 {© 2022 The Bish stat of Nan Destructive Testing RightsReserved ‘This documents protected by UK an intermainal copyriat ls and remains the intellectual property of BINT. Reproduction and estribation ofthe document without the wit permission of BINDT is sity rated PSL S7A Issue 18 Page 9 of 10 ie. dated 1* January 2022 aFORM 1: PSL/30- PRE-CERTIFICATION EXPERIENCE DECLARATION (use more hon 1 sheet if necessary) Heer. oF fetal of the losin NOT ‘requested for addtional technleal zevlew and serutiny. Cant ne ncn oon balsam aes remand gp 3 Enpofng umoatons as pues eto MOC” not merro ft Pues Mowind oil filold Tots hours eames forthe above nuove ume pores: 10, 4OO HOUYS dorvice - Abu thai Raclioywap hic Testing Cosiod oe Bae ‘qualified peron) Name! welded Plates and pifS I ACCOVAANLE | hrsumnntren wits the fotewing thdes aud standoxds ASME SECTION, ASME SECTION @3!-3, Bal-l, BSEN 150 171636 Radiograpluic tosting Gonoval iene Prin ciples - sone can Signatureceptable to PCN providing they address and meet the NOTE: Form 2 (P5130) s included os an example of « format for recording @ candidate's experience. Other formal details inclucied In this form 2 (P5130), FORM 2 PSL/30 ~ CANDIDATE'S LOG OF PRACTICAL INDUSTRIAL NDT EXPERIENCE pe Or Candidate's name: __SELVIN-C. PCN number {if known): i _ NOT METHOD FOR CERTIFICATION ‘made on Form 2 of PSL/: representative” in preperation for the candidate and employer's attestation declaration, which shall be made on (Farm 1) wi prior to the candidate's submission of Form 1 xo PCN for verification. ication is sought should be entered into the white space below. Detalls may include, but nt be limited randards, NDT procedures, written NDT instructions and tecrniques for the testing af the employer's Pon leven -2R1 Candidate: insert | Experience confirmed as satisfactory by, numberof iia as | "arte tre ace anon Nos Ft ach ‘accrued on task: Candidate: insert details of NDT technique 1 code / procedure or standarc applied Radiographic €08HP9 [eott wolots in Plato and x RY Gnd Gasmina rey ae + PSL/30 Issue 14 Page 7of8 24 February 2021