1

CA01

INSTITUTION OF ENGINEERS PAPUA NEW GUINEA INC.

Post Office Box 881 WAIGANI NCD 131, Papua New Guinea
Phone: (675) 325 8763 Facsimile: (675) 3258718 Email: [email protected]

APPLICATION FOR MEMBERSHIP & REGISTRATION

1. Non-refundable processing fee must accompany this application
2. Attach recent passport size photo of applicant

1. APPLICANT DETAILS

IEPNG Membership Number

(If Known)
Surname Title Mr/Mrs/Ms/Miss/Dr/Prof
Other Names Date of Birth
(dd/mm/yyyy)

Preferred Names Gender Male Female

Tick the correct box Expatriate National Country of Origin

2. PLEASE SELECT WHAT MEMBERSHIP CATEGORY AND REGISTRATION YOU APPLYING FOR

Tick the applicable box.

Registration – Application to be registered by the Professional Engineers Registration Board of PNG

Date when registration Date when registration

commences expires (dd/mm/yyyy)
Professional Engineer (PE) (dd/mm/yyyy)

(RegEng)
For Expatriates – this date is
your work permit expiry date
For Expatriates – this date is
your work permit
commencement date

CA01- Owner: Ver1-2020-

 2

IEPNG Membership – Application for membership to the institution of Engineers PNG Incorporated

Category of Membership
Date when Membership Date when
Student Member (StudIEPNG) commences Membership expires
(dd/mm/yyyy) (dd/mm/yyyy)
Graduate Member (GIEPNG)

Technician Member (TechIEPNG)

Companion Member (CompIEPNG)

Member (MIEPNG)
For Expatriates – this date is
Fellow (FIEPNG) your work permit For Expatriates – this date is
commencement date your work permit expiry date
Hon. Fellow (HonFIEPNG)

3. CONTACT DETAILS

Home Address Business Address

Address: Company:

Position:

Address:

Town you are living in Town you are working in

Post Post
code code

Telephone Telephone

Private Email Address (must have one) Company Email Address

Fax Fax

Address you would prefer your mail to go to Home Business

Address to be shown on any register(s) if authorized Home Business

CA01- Owner: Ver1-2020-

 3

4. QUALIFICATIONS

Certified copies of your academic qualification (degree etc) and the academic transcript must be provided
with your application if not previously supplied to IEPNG.

Qualification Discipline Country

Length of Education Provider Year
(State (Engineering Branch) (Country where
qualification (e.g. PNG University of (Year of
Degree/Diploma (e.g. Civil, Mechanical qualification
(Years of study) Technology) Graduation)
or Certificate) etc) acquired)

5. PROFESSIONAL MEMBERSHIPS/ REGISTRATION

Please list any professional memberships, competence-graded registrations or licenses that you currently
hold or have previously held.

Certified copies of your membership/registration/license certificates must be provided with your

application if not previously supplied to IEPNG

Class or Still current? Membership and/ or Year joined

Institution/ Organization
Membership Yes/No Registration Number (Date of
(e.g. Engineers Australia)
category admission)

6. INFORMATION FOR ASSESSMENT PURPOSES

6.1 PRACTICE AREA

All applicants are assessed for competence in their personal practice area. Refer to document
Instructions to fill in Ca01 application Part6 for more information.

CA01- Owner: Ver1-2020-

 4

Use 15 to 25 words to describe your practice area - describing both the nature of your engineering
activities (using words like ‘design’, ‘production’, ‘construction monitoring’ or ‘certification’) and the area
in which you have current knowledge and skills (using terms like ‘electricity generation and reticulation’,
‘biomass fuels’, ‘roading networks’, ‘heavy road transport vehicles’ or ‘reinforced concrete
structures’). Use ‘bullet point’ type statements rather than full sentences. Include supporting evidence
for everything specified in your practice area description and exclude things from the practice area
description that are not supported by evidence. [NB – those seeking registration as a Registered
Structural Engineer under the Building Act 1977 should include ‘Designer of Seismic Capable Structures
in accordance with the detail requirements of the PNG Codes of Practice (or internationally
equivalent) in their practice area description.]

Please copy this information into your Referee Declaration and Evaluation (Form CA06).

6.2 PRACTICE FIELD(S)

Please select one but no more than two engineering practice field(s) within which you believe your
practice area best fits. This information is only used for selecting suitable assessors and has no
relevance to your assessment outcome.

Aviation & Avionics Chemical Geotechnical Mineral Processing

Aeronautical Communications Industrial Oil & Gas

Aerospace Electrical Instrumentation Petroleum

Agricultural Electronics Management Power

Building Services Environmental Marine Surveying

Biomedical Fire Mechanical Transportation

Civil Geology Mining Other

CA01- Owner: Ver1-2020-

 5

6.3 WORK SAMPLES

You are required to present work samples as evidence that you are ‘still able to practice competently’ as an
engineer.

Summarise below what your work samples show:

a) The technological, regulatory and ‘good practice’ changes that have occurred in your practice area
(250 words)

b) The actions you have taken to keep abreast with the changes in your practice area (250 words)

c) The factors that contribute to the complexity of your engineering work (250 words)

CA01- Owner: Ver1-2020-

 6
d) You are still able to practice competently as an engineer (250 words)

6.4 COMPETENCE ASSESSMENT – EVIDENCE CHECKLIST

You may send your portfolio of evidence in electronic or printed form. If your portfolio of evidence is over 2
MB in size, do NOT email it but send it by USB Memory Stick or CD. If you send your portfolio of evidence in
printed form, you must send 1 copy. Refer to the Competence Assessment Registration Guide (CARG) for
details of the documentation requirements:

Check that you have completed all the required documentation and tasks Number copies Please
below required if printed Tick (√)
Application for Membership to IEPNG & Registration to PERB (Form CA01) 1 Copy required
Competence Self Review Form (Form CA03) 1 Copy required
Work History Summary (Form CA04) and updated CV covering
1 Copy required
engineering activities
Continuing Professional Development activities (Form CA05) and CPD
1 Copy required
certificates if attained
Referee Declaration and Evaluation Form (Form CA06) 1 copy required
Certified copy of any academic qualifications and/or professional
1 Copy required
memberships certificates

Supporting work samples (minimum 2) 1 Copy required

A recent Passport size photo 1 Copy required

6.5 ASSESSMENT CENTRE

If you are required to attend an interactive assessment please indicate your preferred location. Individual
arrangements will be made by Assessment panel on date and time to talk to you.

Port Moresby Lae Mt Hagen Kokopo

CA01- Owner: Ver1-2020-

 6

7. REFEREES

Name two referees who are familiar with your engineering activities and can provide comments as to
whether you demonstrate competence in each element of the relevant CBA standards. Referees must
meet certain eligibility requirements – such as being independent. Referees must have been previously
assessed at the level of competence assessment for which you are applying for.

Tick the box to confirm:

 I confirm both referees meet the eligibility requirements

 I have supplied both referees with a Referee Declaration and Evaluation (Form CA06)
and my completed Competence Self Review (Form CA03) and asked them to submit
Form CA06 to IEPNG Head Office.

 I have filled in my application deadline date and my practice area on Form CA06

Referee 1 Referee 2
Name Name

Address Address

Contact Contact
Telephone Fax Telephone Fax

Email Address Email Address

8. IEPNG COMMUNICATIONS AND PRIVACY REQUIREMENTS

8.1 IEPNG COMMUNICATIONS

Please select the level of communication you wish to receive. (Tick one from the option below)

Financial information Only- I only wish to receive my annual invoice for payment and associated
reminders such as Statements (i.e. I do not wish to receive any other IEPNG publications).
IEPNG information - I wish to receive financial information, regular IEPNG publications and
occasional publications of interest such as Informatory Notes and Branch Newsletters.
Marketing Information - I wish to receive all items listed above, as well as information promoting
IEPNG events such as Short Courses and Seminars, Luncheons, Technical Meetings, Conferences,
AGM, etc . From time to time there may also be promotional material from selected suppliers of goods
and services.
Board Elections information - I wish to receive Board Nomination form and also to receive the
Ballot paper to cast my vote
Please Note: In the case of mail outs promoting goods and services provided by other organizations, confidentiality is maintained at all
times through the use of third party mailing houses.

CA01- Owner: Ver1-2020-

 8

8.2 Return of work samples

IEPNG will retain one copy of application documents on file.
Work samples will be destroyed unless you request that they are returned to you.

Tick ‘yes’ to have a copy of any work samples returned to you else tick ‘No’ for the Yes No
samples to be destroyed.

8.3 Publication of Personal Details

IEPNG publishes the names of all Registered Members on the appropriate web-based register. The
names and other information are also published on the PNG Government National Gazette for
Professional Engineers and on the newspapers when required.

9. DECLARATIONS
9.1 Convictions

Do you have any convictions for offences punishable by imprisonment for a term of Yes No
6 months or more? Please provide details of any such convictions below:

Click here to enter text.

9.2 Declarations and Authorizations for Membership/Registration

Please complete the appropriate declarations by ticking the relevant boxes below.

I am applying for IEPNG membership. I agree to be bound by the Rules and Regulations of IEPNG
including the Code of Ethics, which may be amended from time to time.

I am applying for registration as a Professional Engineer. I agree to be bound by the Professional

Engineers Registration Act (PERA) as amended from time to time and the current Professional
Engineers Rules, including the code of ethical conduct, which may be amended from time to time.
I also agree that I will inform the Professional Engineers Registration Board (PERB) of any matters
that may affect my fitness for registration.

For the purposes of assessment I authorize IEPNG Head Office staff and IEPNG-appointed
assessors to contact my referees. I also agree that IEPNG can use reports from any of my
previous competence assessments in evaluating this application.

CA01- Owner: Ver1-2020-

 9

9.3 For Expatriate Applicants ONLY.

Details of your Overseas Registration

Date and Jurisdiction of

Registration Registration Number

Conditions on registration (if any) Click here to enter text.

I certify that:

1. I seek registration in Papua New Guinea as a Professional Engineer in accordance with the
Professional Engineers Registration Act (Amended 2007) in relation to the occupations of the
IEPNG membership and registration class/category.
2. I am currently registered / not registered with another professional body and my registration is
neither cancelled nor suspended. (cross out one)
3. I am not the subject of:
a. Any preliminary investigations or action that might lead to disciplinary proceedings, or
b. Any disciplinary proceedings, or
c. Any special conditions in practicing as a Professional Engineer as a result of criminal, civil
or disciplinary proceedings.
4. I have declared all convictions that could be punished by imprisonment for a term of 6 months
or more.
5. I understand the codes of ethics, legislation and regulations applicable to Papua New Guinea
within my practice area.

I agree to be bound by the current Professional Engineers Registration Act (Amended 2007), including
the Code of Ethics and any amendments as made from time to time. I also agree that I will inform the
Professional Engineers Registration Board (PERB) of any matter that may affect my fitness for
registration. I am aware that I will need to undertake a current competence assessment at intervals not
exceeding three (3) years to remain on the register.

9.4 Certification and Consent

I certify that all information on this form and in my portfolio of evidence is true and accurate. I also
consent to my name being published on the IEPNG website for a period not exceeding 21 days along
with an invitation to the public to provide evidence about whether I meet the competence standard for
membership and registration.

Signature: Date:

CA01- Owner: Ver1-2020-

 1

- - - - - - - - - - - -- - - - - - - - -- - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - -
-------

FOR OFFICE USE ONLY

PAYMENT DETAILS
(Cut this slip only & send with your application forms)

10. METHOD OF PAYMENT

10.1 PROCESSING FEE FOR ASSESSMENT

The Application Form must be accompanied by the prescribed processing fee applicable to the
applicant as per the fee schedule. The total amount of payment enclosed or sent shall include the
method of payment and the cheque or direct transfer details and sent to the IEPNG Office for
processing of your application for membership and registration.

AMOUNT ENCLOSED/SENT K

IEPNG ACCOUNT DETAILS: CASH/CHEQUE/DIRECT DEPOSIT

BSP BANK –WAIGANI CENTRAL BRANCH – 968
CHEQUE ACCOUNT NO. 36191785 Make cheque payable to IEPNG or in full
INTERNATIONAL TRANSFER Institution of Engineers PNG Inc.
SWIFT CODE: BOSSPPGM

- - - - - - - - - - - ------------- - - - -- - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
------

Send your completed application to the Institution of Engineers PNG Inc. at one of the addresses
below:

Courier Address: IEPNG Head Office, Postal Address: IEPNG Head Office
IEPNG HAUS, Unit 2 & 3 PO Box 881
Spring Garden Road Vision City, NCD 131
Gordons, NCD Papua New Guinea
Papua New Guinea

Email: [email protected] Website: www.iepng.org.pg

Phone: +675 325 8763 / 325 8765 Fax: +675 325 8718

CA01- Owner: Ver1-2020-