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1. / The Declaration is made for:
The first performance of the regulated mechanical engineering profession in the Republic of Croatia
2. / Personal information:
First name: / Surname:

Nationality(please check):

AT-Austria / BE - Belgium / BG - Bulgaria / CY - Cyprus / CZ-CzechRepublic
DK - Denmark / EE - Estonia / FI - Finland / FR - France / GR – Greece
IE - Ireland / IS - Iceland / IT - Italy / LV - Latvia / LI - Liechtenstein
LT - Lithuania / LU - Luxembourg / HU - Hungary / MT - Malta / NL - Netherlands
NO - Norway / DE - Germany / PL - Poland / PT - Portugal / RO - Romania
SK – Slovakia / SI – Slovenia / ES - Spain / SE - Sweden / GB – Great Britain
CH - Switzerland / HR - Croatia / Other(please specify):
Personal document (please check): / Identity card / Passport / Certificate of citizenship
Personal document No.: / Date of expiry(MM/YYYY):
Place of issue: / Country of issue:
SEX(please check): / MALE / FEMALE / TIN:

Individual taxpayer identification number ( Tax Identification Number)

Date of birth: / Place: / Country
Personal contact data in the home country (mandatory):
Address(street and number, postal code and city):
Telephone /GSM number (with dialling code):
E-mail:
Contact data in the Republic of Croatia (optional):
Address (street and number, postal code and city):
Telephone /GSM number (with dialling code):
E-mail:
Contact data at the company of employment:
Company name:
Telephone /GSM number (with dialling code):
E-mail:
Contact person:
First and last name:
Telephone /GSM number (with dialling code):
E-mail:
Remark(company name):
3. / Regulated profession or activity:
Professional qualification / regulated professional title in the country of establishment:
I hereby apply for the recognition of my qualification to pursue the following regulated profession from the Register of Regulated Professions or Professional Activities in the Republic of Croatia:

(Specify in detail the professional title and number from the Register of Regulated Professions or Professional Activities in the Republic of Croatia)

Are you qualified to pursue the abovementioned regulated profession in your home country?(please check): / YES / NO
(If YES, please specify a document enclosed herewith proving the qualification and the name of the institution that issued it)
Is this profession regulated in your home country? (please check)? / YES / NO
(If YES, please state the full name of the authority regulating the profession)
Is there a formally organized education for performing the abovementioned profession in your
home country that qualifies you to pursue this profession? (please check) / YES / NO
Name of regulated profession you will be pursuing in the Republic of Croatia:
Have you been authorised to pursue the regulated profession in another EU Member State? / YES / NO
If YES, please name the state and the full name of the authority that issued the authorization(evidence has to be enclosed))
4. / Education and training data:
Name of educational institution (in original language):
Address and country of educational institution:
Professional title in original language:
Duration of education and training:
Start date: / End date:
ECTS credits acquired: / Education level acc. to EQF (European Qualifications Framework):
Certificate of eligibility to pursue the regulated profession issued by the competent authority (please enclose proof thereof) / YES / NO
Other evidence of formal education (please enclose): / YES / NO
Proof of contents and course of training – fields and subjects (please enclose): / YES / NO
Proof of other qualifications (please specify which and enclose): / YES / NO
Acquired qualifications according to EQF – European Qualifications Framework(please check):
primary education – Level 1(8 years) / Level 1 + vocational training for simple jobs– Level 2
vocational education – Level 3(1-2 years) / general secondary education – Level 4(4 years)
professional higher education studies – Level 5 (120 to 179 ECTS credits /more than 2, less than 3 years)
undergraduate university studies and undergraduate professional studies – Level 6(180 to 240 ECTS credits / 3 – 4 years)
graduate university studies, specialist graduate professional studies and post-master specialist university studies – Level 7(1-2 years)
postgraduate research master of science studies– Level 8(2 years) / postgraduate university doctoral studies
Level 8 (at least 3 years)
5. / Croatian language proficiency:
Knowledge of the Croatian language(please check) / YES / NO
If YES, please indicate the level / A / B / C

Language skill levels: A – beginner/breakthrough; B – independent user; C – proficient user.

If you have NO knowledge of the Croatian language, please specify the person whose translation services you will be using in pursuing the regulated mechanical engineering profession in the Republic of Croatia (Statement has to be enclosed)!

First name and surname:
Telephone / GSM number:
E-mail:
Company name:
6. / Professional experience (professional experience in pursuing the regulated profession):
Self-employed: / YES / NO / or Employee: / YES / N0
From (date): / To (date):
Company full name:
Job title:
Job description:
7. / Legal establishment in one or more states:
Are you legally established in any EU Member State to pursue the profession under item 3? / YES / N0
If YES, which is the MemberState of establishment(name of the state)?
If NOT, please explain:
Is the profession regulated in the MemberState of establishment? (please check): / YES / N0
Remark:
If NOT, have you provided the services as a bidder for minimum 2 consecutive years or for an equivalent duration
on a part-time basis during the last 10 years? (please check) / YES / N0
Remark:
Are you a member of any professional association or any similar organization? (please check): / YES / N0
If YES, please specify full name and information on the association / organization and the registration number:
Does the activity need to be approved by the competent authority in the state of establishment? (please check): / YES / N0
If YES, please specify the data on the competent authority:
8. / Professional liability insurance:
Are you covered by an insurance policy or any other personal / collective insurance against professional liability
for pursuing the profession under Item 3? (please check): / YES / NO
IF NO, YOU HAVE TO SUBMITT THE PROFESSIONAL LIABILITY INSURANCE POLICY CONCLUDED IN YOUR NAME WITH MINIMUM COVERAGE OF HRK 1,000,000 PRIOR TO TAKING OVER OF THE CERTIFICATE OF ENTRY INTO THE REGISTER.
Insurance company:
Policy No. /expiry date / insured perils:
Remark:
9. / Please elaborate on the profession you wish to pursue in the Republic of Croatia(description and type of work you wish to pursue):
The work I wish to pursue in the Republic of Croatia(please check):
design engineer / construction supervisor / construction manager / site engineer
10. / POWER OF ATTORNEY: By signing this statement I authorise the below named person to receive on my behalf the documents issued by the Chamber with regard to this Declaration!
First name and surname of the authorised person:
Telephone /GSM number (with dialling code):
E-mail:
BY SIGNING THIS DECLARATION:
  1. I SOLEMNLY DECLARE, UNDER PENALTY OF PERJURY, THAT THE INFORMATION HEREIN CONTAINED AND THE DOCUMENTS AND ENCLOSURES HERETO ARE TRUE AND CORRECT.
  2. I AGREE THAT MY PERSONAL DATA MAY BE COLLECTED, PROCESSED AND KEPT BY THE CROATIAN CHAMBER OF MECHANCIAL ENGINEERS IN ACCORDANCE WITH THE PROVISIONS OF THE PERSONAL DATA PROTECTION ACT.
  3. I AM FAMILIAR WITH LAWS AND REGULATIONS GOVERNING THE ACTIVITIES IN THE FIELD OF PHYSICAL PLANNING AND CONSTRUCTION, AND WITH THE STATUTE AND OTHER ACTS OF THE CROATIAN CHAMBER OF MECHANICAL ENGINEERS.
  4. I ACCEPT THE COMMITMENT TO CONDUCT MY ACTIVITIES PURSUANT TO THE AUTHORITIES STIPULATED BY THE LAW, CHAMBER' INTERNAL RULES AND REGULATIONS, SPECIAL LAWS AND REGULATIONS ENSUING FROM SUCH LAWS.
  5. I AGREE THAT MY PROFESSIONAL DATA FROM THE DIRECTORY OF THE CROATIAN CHAMBER OF MECHANICAL ENGINEERS BE MADE PUBLICALLY AVAILABLE.

Place and date: / Signature:
Documentation required with the Declaration
proof of citizenship - acopy of personal identification document (ID card and/or passport) or certificate of citizenship
university diploma / secondary school leaving certificate and Diploma Supplement/Performance Record
authorisation for pursuing of activities of the designengineer and/or professional construction supervisor, construction manager and siteengineer as a responsible person in the home country – issued by the authority issuing authorisations
for pursuing of the professional activity (not older than six months)
proof of no criminal recordanda proof that the applicant is not subject to suspension or revocation of the right to practice the profession in the home countryissued by a competent body empowered to issue certificate for practicing of regulated profession (not older than 6 months)
evidence of valid professional liability insurance with coverage of minimum HRK 1,000,000 (approx. EUR 135,000)
original and/or copy of the insurance policy issued in the name and valid in the territory of the Republic of Croatia and/or EU
proof/ evidence of professional competences(experience in the profession)- in detail for the last 2 years (Enclosure 1)
statement on the Croatian language proficiency and/or statement on use of translation services (acc. to Item 5. above)
Employer’s Certificate of Employment in the EEA contracting state namely certificate on legal establishment in the EEA contracting state(employment date, job title, jobs performed, etc.)
Receipt on payment of annual membership fees in the amount of HRK 2,280.00 (not subject to VAT).
An evidence of payment of the Chamber procedure fees of HRK 2,000.00 (for physical and legal persons from the Republic of Croatia the fee is increased by VAT).
The payments made by legal or physical persons from the EU Member States or third countries are not increased by VAT, thus it is necessary to submit the payer’s Tax Identification Number used for deliveries or acquisition of goods and services.
PAYER’sTax Identification Number ______
mandatory
PAYMENT INSTRUCTIONS
Primatelj (Payee):HRVATSKA KOMORA INŽENJERA STROJARSTVA (CROATIAN CHAMBER OF MECHANICAL ENGINEERS)
Model
(Pay-ment code)
00 / Account No.
HR5623600001102094156
SWIFT : ZABAHR2X, Zagrebačka banka / Remittance advice
PAYER’s Tax Identification Number
Opis plaćanja (Description):
ČLANARINA I NAKNADA ZA POSTUPAK PROVJERE INOZEMNE STRUČNE KVALIFIKACIJE(MEMBERSHIP FEE AND FEES FOR CHAMBER PROCEDURE - APPLICANT’S FIRST NAME AND SURNAME)

Note:

Documents are submitted translated into the Croatian language and in copies while the original document shall be submitted upon request of an authorized person.

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ENCLOSURE 1:PROFESSIONAL COMPETENCES OF THE APPLICANT

First name: / Surname: / Professional title acquired:

Remark: Please enter only the professional engagements on a project or part of a project you have personally carried out (extend the table if necessary) during the previous 2 years

as a responsible design engineer (P) and/or as construction supervisor (N) and/or as construction manager(VG) and/or site engineer (VR)

No. / Duration of professional engagement
from MM.YYYY
to MM.YYYY / Name of project or part of project on which you have been engaged in your professional capacity / Brief description of the professional engagement and Applicant’s position / Type of work (please enter)
DESIGN ENGINEER(P)
SUPERVISOR(N)
CONSTRUCTION MANAGER(VG)
SITE ENGINEER (VR)
Place and date: / Signature: