FORM ERB/REG/F2.1/1.

1
ENGINEERS REGISTRATION BOARD
Postal Address Physical Address
P. O. Box 1909 Unit 3 & 4, Plot 145
AAD Poso House Kgale Lake View Office Park
Gaborone Gaborone
Tel: +267 391 4446
Botswana
Fax: +267 397 3626
email: renewals@erb.org.bw Web: www.erb.org.bw

APPLICATION FOR PRACTISING CERTIFICATE

A1.1: PERSONAL DETAILS
1: TITLE 2: FIRST AND MIDDLE NAMES 3: SURNAME 4: GENDER

M F

7: PASSPORT DETAILS
5: NATIONALITY 6: ID NO. (for Botswana Citizens)
(Non-Botswana Citizens)
Passport No.
Expiry Date:

8: POSTAL ADDRESS 9: PHYSICAL ADDRESS 10: CONTACT DETAILS

Tel:
Mobile:
email:

A1.2: CURRENT EMPLOYMENT DETAILS

11: NAME OF ORGANISATION 12: DESIGNATION 13: CONTACT DETAILS
Tel:
Fax:

Website

A1.3: ENGINEERING CATEGORY & DISCIPLINE FOR PRACTISING

14.1: ENGINEERING CATEGORY 14.2: ENGINEERING DISCIPLINE 14.3: CURRENT CERTIFICATE EXPIRY DATE
(e.g. Professional/Graduate) (e.g. Electrical, Civil, etc.) (if applying for renewal)

A1.4: NUMBER OF CPD CREDITS ATTAINED

15: CPD CREDITS ATTAINED IN CURRENT YEAR
NB: Attach CPD logbook

DECLARATION
I hereby apply for a practicing certificate and undertake to abide by all provisions of the Engineers Registration Act, 2009, and any
regulations and by-laws made there under including Code of Professional Conduct and Ethics. I certify that, to the best of my knowledge,
the information contained herein is true and correct.

Date: Signature of Applicant:

FOR OFFICE USE ONLY

Date Application Received:
Date Certificate Issued:
Certificate Expiry Date:
Amount Paid:
Issued by (Name and Signature):