/ Testia Limited
Quadrant House, Celtic Springs, Coedkernew,
Newport, Gwent. NP10 8FZ
Telephone: 01633 713000
/ EMPLOYER BASED LEVEL 1, 2 & 3 EXAMINATION FORM /
Please complete all sections and return to Testia Limited (see details in footer)

SECTION A: Your examination details

Full Name (as you would like it to appear on your certificate)
Position in Company
Method for Examination (MT, PT, ET etc)
Level (level 1, level 2 or level 3)
Exam Type (Initial, Re-Certification or Re Sit)
General Theory required Yes/No
Qualification Specification (EN4179 or NAS410)
Examination Date
Level 1 & 2 Certification Currently Held
ASNT (Methods)
PCN (Methods)
Other (Methods)
None
For Level 3 examinations only
Basic exam (i.e. Basic, RT, ET, UT, PT, MT)
Level 3 Only
Level 3 & Level 2 Practical
Level 3 Certification Currently Held
ASNT (Methods)
PCN (Methods)
Other (Methods)
None
Do you currently hold Level 2 Practical in the Method for the examination sought? Yes/No
LEVEL 2 PRACTICAL EXAMINATION (Only complete if Level 2 Practical is required)
·  Choose in the below table which techniques you want to have included in the Examination
·  Chosen techniques must be in accordance as those defined within the company’s Written Practice & Approved by your Company’s Responsible Level 3
Radiography / Ultrasonic / Eddy Current / Magnetic Particle / Penetrant
Film / Contact / High Frequency / Direct Contact / Type 1 Method A
Real time / Immersion / Low Frequency / Threader Bar/Central Conductor / Type 1 Method C
Components / Metallic / Rotary / Coil / Type 1 Method D
Casting / Composite / Yoke/Electromagnet
Structures
Welds
Please include here any additional requirements you would like to be included or not included in the examination.
The following signatures are required which will form a Contract for Examination between TESTIA LIMITED and your company.
For the Company:...... Responsible Level 3......
Name ...... Name......
Position...... Date......
Date......
Essential Documentation to be provided prior to examination
Written Practice
Prior to administration of qualification examinations a copy of the Employer’s Written Practice is required four weeks prior to the examination.
If your Company does not have a Written Practice would you like to discuss its preparation with TESTIA LIMITED?
c Yes c No
Specific Theory Examination
Please write in the space below which standards / specifications your company uses when carrying out NDT Inspections in the NDT Method of examination sought, revision numbers and issue numbers of each standard / specification must be stated.
You must supply electronic current copies of the requested specifications / standards 4 weeks before the date of examination.

SECTION B: Company Details

Company Name
Company Address
Telephone Number
E-mail Address
Invoicing Address (if different from company address)
Proposer and Position in Company
VAT Number
Payment Terms:
Payment is due 14 days prior to the session, you will not be able to attend the session if payment is not received.
Any cancellation more than 1 week before the session will incur a 10% administration charge.
Any cancellation less than 1 week before the session will incur a charge of 50% of course fees

SECTION C: Other

Please specify if you have any dietary or religious requirements.
Please specify if you have any specific requirements for building access.
Please specify if you require any taxi services

SECTION D: Hotel accommodation

Do you wish Testia Ltd to book a hotel on your behalf? / Yes / No
Preferred Accommodation
(your Hotel preferences or selection from list provided)
Number of nights?
Date from:
Date to:
Room type: / Single / Double
Breakfast included? / Yes / No
Note:
Testia Limited will make hotel reservations when requested. All payments for accommodation must be made by the student direct to the hotel. Testia Limited will not pay any account sent in by a hotel. When Testia Limited has guaranteed hotel accommodation on behalf of the customer, the hotel will hold the room regardless of arrival time. Testia Limited is not responsible for the cost of accommodation in the event of a non-arrival. Cancellations must be made by the student in line with the policy of the hotel.

Hotel Listing:

We have a number of preferential rates with local hotels.
Should you wish Testia to book one of these for you then please state the named hotel along with the relevant dates on the above table.
Hotel / Distance from site / Rates starting from
The Holiday Inn Express
Celtic Springs, Newport. NP10 8BB / 0.5 miles / £69 B+B per night
Holiday Inn
Coldra, Newport. NP18 2YG / 8.2 miles / £68 B+B per night
The Thistle Parc Hotel
Cardiff. CF10 3UD / 9.4 miles / £68 B+B per night
Celtic Manor Resort
Newport. NP18 1HQ / 8.3 miles / From £68 B+B per night
There are other accommodation options listed below:
Should you wish to book one of these then please contact them on the phone numbers provided.
Hotel / Distance from site / Preferential rate / Telephone
Celtic Springs Guest House, Newport. NP10 8TN / 0.4 miles / £30 per night / 01633 807769
The New Inn, Newport. NP18 2JN / 9.3 miles / £30 per night / 01633 412426
Premier Inn Coldra, Newport. NP18 2NX / 8.4 miles / £65 per night / 08715 278814
TESTIA-UK-GEN-011-F11-EN issue 2.0
© Testia Ltd. – all rights reserved / Page 2 of 5
When you have completed this form, please keep a copy for your own records and return a copy as an email attachment to or by fax to +44 (0) 1633 713 333