APPENDIX 1

EXOVA (UK) LIMITED TRADING AS WARRINGTON CERTIFICATION
FIRE RISK ASSESSMENT CERTIFICATION SCHEME (INDIVIDUAL)
APPLICATION FORM
I, (insert name)…………………………………………wish to apply for certification as a competent person; able to provide; “Fire Risk Assessments of Buildings for the purpose of Life Safety in accordance with The Regulatory Reform (Fire Safety) Order 2005” “The fire (Scotland) act 2005 (sections 53-59)” and “The Fire safety (Scotland) Regulations 2006”
Company Name and Address
Position in Company
Give brief description of your activities relevant to fire risk assessments
Address for entry on certificate, if different from above
Tel:
Email :
Supporting Documentation Checklist – further details can be found in Prices and Stages Document
a)  Detailed CV
b)  Copies of qualifications and other supporting certification
c) 2 Complete risk assessments
d) Head and shoulders photo in .jpeg format.
Please List by title your submitted risk assessments;
Documentation may be submitted in electronic or paper format
All owners of my submitted reports have granted consent to use them as evidence and they agree to provide a verbal reference if contacted by Exova (UK) Limited trading as Warrington Certification / If the answer to this question is No (Contact scheme administrator before submitting)
Date
Signature
By signing this application form the candidate agrees to comply with the scheme regulations current at the time.

Office Use Only

Application Reviewed by:
(In accordance with scheme manual) / Signature: / Dated:

Please return this form to:

Exova (UK) Limited trading as Warrington Certification

Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom.

Co. Reg. No. SC070429

Doc. Ref: EWC-QU-FT-67 (Issue 6 - 22/04/2016)