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PROCUREMENT AND SUPPLIES PROFESSIONALS AND TECHNICIANS BOARD

P.O. Box 5993, DAR ES SALAAM - TANZANIA Tel: 2865860 Tel/fax: 2862138 E-mail: [email protected] Website: http://www.nbmm.or.tz

(Established under the Act of Parliament No. 23 of 2007)

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APPLICATION FOR CANDIDACY REGISTRATION

(Before filling in this form please study carefully the Registration procedures and regulations and guidance notes)

SECTION A: PERSONAL PARTICULARS: 1. Name: .................................... ............................................... .................................

First Name Other Initials Surname

2. Gender: Please tick (

) in the appropriate box:

Male

Female

3. Contact Address for posting examination documents ....................................................................................................................................... ............................................................E-Mail .................................................................. 4. Date & Place of Birth: ..........................................

Date

.......................................................

Place

5. Nationality: ........................................................ 6. Present appointment .............................................

Post

Tel/Mobile No:....................................... ........................................

Date

7. Name & address of present Employer: ....................................................... ...................................................

Name Address

8. Qualification: S/N Name of Institution/school From Dates To Award

9. I desire to sit for the Procurement and Supplies Professionals and Technicians Board Examinations and I am currently preparing for the: Basic Stage I II Foundation Stage I II Professional State II III IV

I

V

RP

10. I enclose Cheque No................... for Tshs...............as payment of Candidacy Registration fee. Alternatively, payment can also be done through Banks to our NBC Corporate Branch A/C No. 0111 0301 7252. or NMB Bank House Branch A/C No. 2013500374. In this case enclose bank pay in slip with this form. PLEASE DO NOT POST CASH. 11. I have read and agreed to abide by the Board's Registration Regulations and accept that any false information supplied by me will invalidate my application. ................................................ Applicant's signature .................................................... Date

SECTION B: CERTIFICATION I certify that the above named applicant has been known to me for ............year (s) and that his/her character is such that he/she is fit and proper to take the examinations of the Board, and that to the best of my knowledge, the above information is correct. .................................................... Date.........................20...

Signature of Employer/ Head of Training Institution/Parent/Guardian With official stamp (if any)

SECTION C: GUIDANCE NOTES For completing forms for Candidacy Registration and Examination entry, the following notes should be read in conjunction with the relevant sections of Candidacy Registration Application Form. 1. Recently taken photographs two (2) passport size and two- (2) stamp size. (With your names written on the back of each one) must be submitted with this form. 2. Use block letters: Write your full name starting with your first name in the space provided. 3. Photocopies of Certificates certified by the issuing authority must accompany this application. Alternatively, they may be delivered personally to the Board for certification by the Examination Department of the Board. Original Certificates should never be forwarded or sent by post. 4. Incomplete form and forms not supported with relevant documents and appropriate fees will not be processed. 5. Candidacy Registration deadlines for the May and November Examination Session are 28th February and 31st August respectively. Late application within two weeks after deadline will be charged a penalty of 30% of the respective fee. No application will be accepted thereafter. SECTION D: EXAMINATION ELIGIBILITY Registration accepted/rejected for the following reasons: ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. Candidate qualifies for examination in the following stage (please check in the appropriate box below) BI BII FI FII PI PII PIII PIV PV RP

Examination Centre................................................................................... Candidate's documents checked by: ....................................... ................................ .....................

Name Signature Date

Receipt no...................... of Tshs................... Received by ........................... Date .................. This form is not valid without Registrar's Stamp & signature

Approved:

......................................... Executive Director Procurement and Supplies Professionals and Technicians Board.

PSPTB P.O. Box 5993 Dar es Salaam Tel: 022 2865860 Fax. 022 2862138

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