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Personal Information:

Initials:

First names:

Surname:

Title:

Date of Birth:

Contact Details:

Telephone Home:

Telephone Work:

Cellular:

Fax:

Email Home:

Email Work:

Primary Postal Address: (the preferred address for correspondence. Home or Work)

Postal Code:

Secondary Postal Address: (the alternative address for correspondence. Home or Work)

Postal Code:

Certificates of Competency:

Mines Electrical: Cert No: Date of Issue:

Mines Mechanical: Cert No: Date of Issue:

Factories Electrical; Cert No: Date of Issue:

Factories Mechanical: Cert No: Date of Issue:

ECSA registration:

ICMEESA is recognised by ECSA as a voluntary association. ECSA grants, in terms of section 12(2) of the Act, a reduction in annual fees, payable by registered persons, who are members in good standing of a voluntary association.

Category: Reg No:

The Institution of Certificated Mechanical and Electrical Engineers, South Africa