Rev. No.
: 0
Date: 13.11.2016
BEM/Form/APP/10
COMPANY LETTERHEAD
Our Ref: (if applicable)
Date:
Registrar
Board of Engineers Malaysia
17th Floor Block F JKR Headquarters
Jalan Sultan Salahuddin
50580 Kuala
Lumpur Dear Sir,
STATEMENT OF PRACTICAL EXPERIENCE
FOR …………………....................................(Name of Applicant)….........................................................................................
With reference to the above, I hereby confirm that .................. (Name of Applicant) Muhammad Azizan Bin Mohd Zaki has
worked as an engineer in our firm/division from * …........ (date/month/year).............................. until
................(date/month/year)............
Period Statement of Practical Experience
Please specify the Please state the post held and summary of the work the applicant has undergone here.
exact date of
service. Note:
If the applicant have worked in more than one department/company in the 3 years (or more),
he/she is required to submit two or more statements of practical experiences certified by the
respective registered Professional Engineer under whom he/she has undergone the
experience.
• Where space provided is insufficient, please attach annexed sheet.
I certify that .................................. (Name of Applicant) ............................................ has acquired satisfactory practical
experience as a Graduate Engineer and meets the requirements of Section 10 (1) (b) of the Registration of Engineers Act
1967 (Revised 2015).
Yours faithfully,
..................................................................................
(Signature of a Professional Engineer under
whom applicant have obtained the experience)
Name : ….....................................................................................................
Position : ….................................................................................................
Registration No. : ….................................................................................... …...................................................
Branch of Engineering : .......
….......................................................................... (PE/PEPC Stamp)