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Information about the scope of certification

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APPLICATION FOR CERTIFICATION OF PERSONNEL MAKING PERSONAL CONNECTIONS

FORM.1-EUCERT/PR/CPS

Issue no. 2 2023-03-30

Type of examination:

Body certifying personnel performing permanent connections

Name:

EU-Cert Sp. z o.o.

Vat No:

5851497842

E-mail:

office@eucert.pl

Address:

ul. Karola Szymanowskiego 12/U6, 80-280 Gdańsk

PCA accreditation number:

AC 230

Name:

EU-Cert Sp. z o.o.

Vat No:

5851497842

PCA accreditation number:

AC 230

ul. Karola Szymanowskiego 12/U6, 80-280 Gdańsk

office@eucert.pl

Dane wnioskodawcy (pracodawcy)1):

Manufacturer's name:

Address:

* *

Person authorized to submit an application/contact EU-Cert:

Telephone / e-mail:

Dane kandydata wykonującego połączenia nierozłączne2):

Name and surname:

Address

Number of welder's/operator's booklet (if issued)

Date and place of birth3):

Place of work:

* - completion of this field is optional

Proposed scope for examination:

Qualification standard with permissions 2014/68/UE:

Exam scope based on:

Details of the bonding process:

Process number according to EN ISO 4063:2023:

Group of basic material according to ISO/TR 15608:

Thickness of base material [mm]:

Welding position according to EN ISO 6947:2019:

Details of butt/fillet weld execution:

Type and polarity of current:

Method of binder transfer4):

Group, designation of additional material:

Weld thickness (only for BW or B) [mm]:

Type of weld:

Shielding gas according to EN ISO 14175:2008 / Flux

Supplementary joint with fillet weld in PB position:

Product type:

Type of additional material:

Pipe outside diameter [mm]:

Kind of weld:

Backing type:

Additional information on EN ISO 14732:2013:

Type of welding (fill in one of the options):

Backing:

Kind of bonding

Connector tracking:

Weld filler insert:

Type of welding / sealing station

Curve length control:

Welding groove

Visual control

Distance [mm]

Additional information regarding EN 13585:2012:

Binder type according to EN ISO 17672:

Binder flow direction

Method of binder dosing:

Degree of mechanisation:

Type of joint:

Other core variables:

Overlap length [mm]:

* - completion of this field is optional

Mandatory annexes to be provided with the application

Comments
  • The offer, together with the contract, will be sent after a substantive review of the criteria declared in this application
  • The application form and the signed contract must be submitted in the original no later than the day of the examination
Commitments
  • Comply with the relevant provisions and rules concerning the certification of welding personnel,
  • Not to disclose confidential exam materials or participate in fraudulent practices during the exam,
  • To familiarise themselves with the Welding Personnel Certification Scheme published on www.eucert.pl,
  • To use the certificate in accordance with the scope of qualification obtained,
  • Not to use the certificate in a manner that may jeopardise the good name of EU-CERT and not to make statements that EU-CERT may consider misleading or unauthorised,
  • Upon suspension or revocation of a certificate, cease using and relying on the certificate and return the certificate to EU-CERT,
  • Use your certificate only to document the scope of your privileges,
  • Not to use the certificate or report, or any part thereof, in a misleading manner,
  • To promptly inform EU-CERT of issues that affect its ability to continue to meet certification requirements.

PART FOR LEGAL ENTITY

PART FOR NATURAL PERSONS (ALSO ONE-MAN BUSINESSES):

INFORMATION ON THE RIGHT TO WITHDRAW CONSENT

YOU HAVE THE RIGHT TO WITHDRAW YOUR CONSENT TO THE PROCESSING OF YOUR PERSONAL DATA AT ANY TIME. WITHDRAWAL OF CONSENT WILL NOT AFFECT THE LAWFULNESS OF THE PROCESSING WHICH WAS CARRIED OUT ON THE BASIS OF YOUR CONSENT BEFORE ITS WITHDRAWAL.

Approval no 1

Zgoda nr 2

Zgoda nr 3

Annex 1 - Information clause for natural persons (including sole traders, CEIDG), as well as for the applicant and the candidate            Go to

* - completion of this field is optional