/ Application for Approval of
Assessor / Internal Verifier
Mr/Mrs/Miss/Ms/etc
/ Surname
Forenames
Home address
Post Code
Telephone / E-mail
D.O.B / D / M / 19 / NI
Please tick approval(s) sought / Assessor / Internal Verifier
I agree to declare any conflicts of interest and be independent and impartial in respect of all applicants, treat all information provided by NICEIC Certification in respect of Certification Schemes as confidential and further more that I will not disclose any information to any third party without the written consent of the NICEIC Certification Scheme Manager.
In addition I agree to keep NICEIC Certification updated with copies of my assessments / qualifications.
Applicants Signature / Date
Centre Manager Name / Signature
1. Indicate date ‘awarding’ date for any Assessor/verifier and/or SNVQ qualifications you hold.
2. Enter ‘expiry’ date other qualifications - Copies of all qualification(s) and CV must accompany this application
D or A&V
/ Aw Date / LPG / Ex Date / Commercial / Ex Date / Meters / Ex Date / Others / Ex Date
D32 / A1 / CCLP1 / COCN 1 / CESP 1
D34 / V1 / CoNGLP 1 / CoDNCO1 / CMA 1
D35 / V2 / PD / BMP 1 / MET 2
Domestic / Ex Date / RPH / CCP 1 / CMET 1
CCN 1 / LAV / CDGA 1 / CMET 2
CENWAT / B / CGFE 1 / MET 4
CKHB 1 / EP / CIGA 1 / CoDNESP 1
CKR 1 / MC / CORT1 / REGT 1
CMDDA1 / HTRLP 2 / ICPN 1 / REGT 2
CPA1 / HTRLP 3 / TPCP 1
DAH 1 / REFLP 2 / TPCP 1A / Catering / Ex Date
DFDA 1 /
WATLP 2
/ / CCCN 1
HTR 1 / VESLP 1 / CCLNG 1 / COMCAT 1
HWB 1 / VESLP 2 / CLE 1 / COMCAT 2
LAU 1 / EFJLP 1 / COMCAT 3
LEI 1 / CABLP 1 / COMCAT 4
MET 1 / WAHLP 1 / COMCAT 5
WAT 1 / CoDC 1
Oil / Ex Date / CoLPNG 1 / Limited Sc. / Ex Date / CoCATA 1
OFT 101 / CMA 2LS
OFT 102 / Non Accredited / Ex Date / MET 3LS
OFT 103 / Unvented H W / ICAE 1LS
OFT 105E / Basic Electric’s / ICPN 1LS
OFT 600A / System Electric’s / COCNPI 1LS
Combi’s / CMIT 1LS
NIEIC use only / Date / Assessor/Verifier approval number
Approved by Signature / Approved by Name
NCL/QA/53 / Page 1 of 1 / © NICEIC Certification 06/15