APPLICATION FORM Document no.

: F50E

Rev. No. : 3
: 1 of 1
CSWIP 3.1 LEVEL 2
Page no.

Datum : 1/7/2018
Location: LPMW Breda, Weidehek 24, 4824 AS, Breda, the Netherlands
*Please fill in the form and send to: info@dt-welding.nl or j.ottevanger@lasinstituut.nl
*This form is for one student only
*Participation is only possible if all conditions are met as stated in the program list under "entry requirements and documents
needed" in the form CSWIP 3.1 level 2 course inspection
*Upon receipt of all required forms / documentsyou will receive a confirmation and invoice for the course, the invoice MUST
be paid in advance of the course.
* Costs are according pricelist "F81E-CSWIP pricelist" (Attached to this application form) all prices are without VAT.
*Hotel nights are including breakfast.
*Included for each course: lunch, drinks during the course, course notes and TWI weld gauge

Course Mark yes

ID no. TYPE OF COURSE or no
1a CSWIP 3.1 INITIAL course (No e-learning), 5 days ONSITE
1b CSWIP 3.1 PLUS INITIAL course, 5 days ONSITE and the standard PLUS e-learning
1c CSWIP 3.1 PLUS INITIAL course, 5 days ONSITE and online e-learning with assigned tutor.
1d CSWIP 3.1 PLUS ONLINE course, 2 days ONSITE and online e-learning with assigned tutor.
2a CSWIP 3.1 PLUS ONLINE e-learning with assigned tutor. (Only e-learning)
2b CSWIP 3.1 PLUS 2 days ONSITE (Only combined with 2a or 2a is already been performed
PERSONAL DATA
a Salutation (Miss or Mr.)

b First name

c Last name

d Proffesional function

e Department

f Address

g Zip code / Place

h Phone no.

i Email address

Hotel stay, Yes or No

Hotel check in date

j
Hotel check out date

Hotel total no. Of nights

INVOICE ADDRESS
k Company name

l Contact person

m Address

n Zip code / Place

o Phone no.

p Email address
Company VAT no. ((Required if not in the
q Netherlands)
SIGNATURE and COMPANY STAMP FOR APPORVAL

For more information please contact:

DT-Welding Weldconsultancy B.V. * Address: Dorpsstraat 72, 1689EW, Zwaag, The Netherlands * Phone: +31 (0)6-52638264 * Email: demko.tol@dt-welding.nll *
WWW.DT-Welding.nl Or below
De Groot LPMW Lasinstituut * Address Weidehek 24, 4824 AS, Breda The Netherlands * Phone +31(88)-1344555
* Email: J.Ottervanger@lasinstituut.nl