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510_NewApp_2012

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API 510 Pressure Vessel Inspector Certification Program  Ap pl icati ic ati on Ins tr uc ti on s 1. This application is a writable PDF. Please make sure to download the application document and save it on your computer. You can then open the application, type in your information, and print the application forms. (Any application filled in while viewing it online will not be saved, nor will it be sent to API electronically.) All applications must be mailed to mailed  to API. 2. Fill out all pages of this application completely. 3. Please enter your name as it appears in your passport / government-issued ID / driver’s license. 4. If you have previously applied to API and been assigned an API ID number, include it every place that your name appears. 5. Be sure to include a unique and current e-mail address. All API correspondence including your admission letter and exam score report will be sent to the e-mail address you provide. 6. Make note of tthe he applicable documents to to study as listed listed on the Publications Effectivity Sheet. The publications for ICP certification certification exams may be ordered through IH IHS S (www.techstreet.com)) (www.global.ihs.com) www.global.ihs.com) or TechStreet (www.techstreet.com 7. You must include a verified Employment Employment Reference Form (ERF). (ERF). The ERF may be validated either by a public notary or by your your employer. See Page 7 for full instructions. 8. Read and sign BOTH BOTH Inspector Agreements 9. Include the c certification ertification fee. See Page 2 for ICP Financial Policies. We will n ot pro cess any application until full payment is received. 10. Be sure to keep a copy of the completed application that you mail to API, including copies of your ERF, diplomas, employer letter, etc. 11. When you have completed your application see checklist at the back of this packet to ensure you have included all the information and documents necessary.

INFORMATION FOR THE DAY OF THE EXAM:   Youareallowedtohaveonlythefollowinginthetestroom :APIpermittedtestreference 

materials,sharpenedNo.2pencils,aneraserandacalculator(simplefunctiononly,nonprogrammable).Anythingelsecouldbeconfiscatedbytheteststaff.   Anyadditionstothereferencematerials thereferencematerialsarenotallowed arenotallowed..Thisincludestrainingmaterials,any    Anyadditionsto



pagesinsertedinyourcodebooks,preprintedandinsertedlabels,andhandwritinginthe blank/half-blankpagesofthecodebooks.Smallnotesinthemarginsarepermitted.Violations willresultintheteststaffconfiscatingpagesofreferencematerials.

510_2012 (Revised)



 

ICP FINANCIAL POLICIES Payment Policy  API cann c ann ot pr oc ess any app li c ati on un ti l f ul l paym p aym en entt i s r ece eceiv ived ed.. No exceptions will be made under any circumstances. Candidates WILL NOT BE PERMITTED TO TAKE AN ICP EXAMINATION if payment has not been received AND processed by API. Proof of payment

must be included with your application. application pplication   API must RECEIVE your ORIGINAL application by mail on or before the a deadline .



   All payments payments must b be e made in United Sta States tes curre currency. ncy.



  Paying by credit card provides the best opportunity to ensure that payment is received and processed by API in the timeliest manner. 



  Checks must be drawn from a US bank. You are responsible for all taxes, banking or



other service fees, including all applicable withholding taxes.   If your company is going to pay the fee make sure they know the deadline and allow



plenty of time for the company to make payment.   If paying by wire transfer please submit a copy of the electronic transaction document with your application. The applicant’s name MUST be included on the wire transaction document. If the copy is not included with the application please e-mail a copy to [email protected]  as soon as possible to allow time to identify the payment and schedule [email protected] as you for the exam.



Refund Refund Policy    All

requests for ref requests refunds unds must be submitt submitted ed to AP APII in writing by mail, ee-mail mail or fax and requested within 6 months of the date of the payment.   For refund requests made before the application deadline:    API will refund refund the initial ce certificatio rtification n fee less $100.00 for proce processing. ssing.   For refund requests made after the application deadline:    API will refund Resch sch edule fees a are re nonrefund 50 50% % of the in initial itial certif certification ication fe fee. e. Re refundable.   For refund requests made after the date of your examination:   No refunds will be issued whether you took the examination or not. 





510_2012 (Revised)



 

Application Form – Basic Information API 510, Pressure Vessel Inspector Certification Program 

New – API Exam New – National Board

EXAM ID

(if previously assigned) 

(Must include proof of NBIC certification)

KUMAR VIJAYARAJ  ___________________________________________________________________________________________  ____________________________________________________ _______________________________________ FIRST MIDDLE LAST NAME (please NAME  (please spell it the same way as it appears on your passport / driver’s license) li cense) #15, BALASUBRAMANIYA NAGAR, EB COLONY, 2ND STREET, MAHARAJAPURAM

05/15/1983

Home Address (Number and Street)

Date of Birth (Month / Day / Year)  Year) 

VILUPPURAM. PINCODE:605602. TAMILNADU

00919843436423

City, State and Zip or Postal Code

Home Telephone Number

INDIA

[email protected]

Country

Personal Email ( At  At leas t o one ne UNIQUE E-MAIL REQUIRED)  REQUIRED) 

Employer Data

0096822005121 Work Telephone Number

ADVANCED OILFIELD TECHNOLOGY COMPANY LLC

[email protected]

Employer

Business Email (Unique e-mail – not shared)  shared) 

Employer’s Address (P.O. Box or Number and Street)

Cell Phone Number

PO BOX:223, PC:124, RUSAYL, MUSCAT

City, State and Zip or Postal Code

0096896900946

If you want your exam admission letter / score report to be sent to your employer, trainer, or exam organizer, please include this person’s e-mail here:

 

SULTANATE OF OMAN Country

510_2012 (Revised)

Group Contact E-mail



 

Additional Information API 510, Pressure Vessel Inspector Certification Program 1.  1. 

2.

Mailing and Directory Addresses -- Please Mailing Please check the appropr iate boxes regarding you r preference prefere nce for mailing and directory addresses. Please Please be sure to check one box only fo r ea each ch question. At which address do you wish to receive your certificate?



Home

Work

Are you interested in being included in the on-line API Inspector Directory, when you obtain your certification?



Yes

No

Which address do you want shown in the ICP Directory listing?



Home

Work

Do you currently have an active API certification?

Yes 



 No 



 No 

If yes, enter your certification number and expiration date. If you answer yes, you need not complete the Education and Training Form.

3.  3. 

Program / Certification Number

Expiration Date

Program / Certification Number

Expiration Date

Program / Certification Number

Expiration Date

 Ar  Are e you yo u cur c ur ren tl y a fu ll -time, -ti me, n non on -co nt rac t em empl pl oyee oy ee of an API member company?  company?  

Yes 

If yes, please enter the company name.

4.  4. 

Please check the boxes that correctly describe your organization. Plea Please Please se be sure to check one box o n each side. Industry

PETROLEUM 



CHEMICAL  PAPER /PULP 

5.  5. 

Organization Organiz ation type

OWNER -U -USER   

I NDIVIDUAL CONTRACTOR   I NSPECTION COMPANY 

SERVING ALL I NDUSTRIES 

CONSULTING/CONSTRUCTION 

OTHER  

OTHER  

Please check Please check the boxes that co rrectly describe your employment status. Please Please be sure to check one box only. 

Full-time employee of an owner/user Full-time employee of an inspection agency/other company Independent contractor  

510_2012 (Revised)



 

Education and Training API 510, Pressure Vessel Inspector Certification Program Please attach copies of your school / university diplomas

High School / Secondary School VILUPPURAM, TAMILNADU, INDIA - PIN:605602

1998

 Name

Location

Year Graduated

 Name

Location

Year Graduated

RAILWAY MIXED HIGH SCHOOL

Trade / Vocational School

03 YEARS

DIPLOMA IN AGRICULTURAL ENGINEERING

2001

 Name

Duration of Studies

Field of Study

Year Graduated

 Name

Duration of Studies

Field of Study

Year Graduated

 Name

Duration of Studies

Field of Study

Year Graduated

SAKTHI INSTITUTE OF TECHNOLOGY

College / University IFET COLLEGE OF ENGINEERING

MECHANICALENGINEERING

BACHELORS OF ENGINEERING

 Name

Duration of Studies

03

Major

Degree Type

Dates Attended

 Name

Duration of Studies

Major

Degree Type

Dates Attended

 Name

Duration of Studies

Major

Degree Type

Dates Attended

510_2012 (Revised)



 

Employment History  API 510, Pressure Vessel Inspector Certification Program (Last three employers or at least the last five years)

1.

Name and Addr ess of Employer (Current) ADVANCED OILFIELD TECHNOLOGY COMPANY LLC

Date of Employ ment  ment   From:

Employer

18-JULY-2008  ___________________

PO BOX:223, PC:124, Mailing Address (Number and Street)

To:  ____________________ TILL DATE

RUSAYL, SULTANATE OF OMAN 0096822005121  ____________________ Employer’s Telephone

City, State and Zip Code

Job Title / Description Description of Responsibilities

2.

Name and Addr ess of Employ er Employer

Date of Employm ent  ent   From:  ____________________ To:

Mailing Address (Number and Street)

 ____________________

City, State and Zip Code

 ____________________ Employer’s Telephone

Job Title / Description Description of Responsibilities

3.

Name and Addr ess of Employ er Employer

Date of Employm ent  ent   From: 18-JAN-2010  ____________________ To:

Mailing Address (Number and Street)

 ____________________

City, State and Zip Code

 ____________________ Employer’s Telephone

Job Title / Description Description of Responsibilities

510_2012 (Revised)



 

Verification Requirements for Employment Reference Forms (ERF)

 Al l p aper wo r k d oc um ent in g t he ap pl ic ant ’s w or k ex per ien ienc c e MUST be o ori ri gi nal na l documents. Photocopied, sca scanned, nned, or faxed documents will not be processed.

The Employment Reference Form attached to this application must verify the required length of experience based on your level of education. This experience must have been acquired within the last 10 years. Please make copies of the ERF and provide one form for each employer if it is necessary to meet the requirements.  API requires requires that tthe he super supervisor visor sign signs s any ERF that is s submitted. ubmitted. Supervis Supervisors ors may on only ly sign for the experience acquired while at their company. This signature must be validated by a notary public, Commissioner of Oaths or similarly licensed official. API requires proof of the validating authority such as a notary stamp, a copy of the license, etc.

 Al ter n ati ve Met ho d o f ERF Ver Verif if ic ati on FOLLOWING LOWING If a notary is not available in your country then AL L THREE OF THE FOL REQUIREMENTS MUST BE MET to complete and verify the documentation of your employment:

1. The ERF must be signed by a supervisor. 2. The ERF must be stamped with a company stamp instead of the notary stamp 3. 

In addition to the ERF the applicant must provide an “employment confirmation letter”. This letter must be submitted on company letterhead, and signed by an individual other than your supervisor - a higher company official such as department manager, director, vice-president. The letter must confirm that the applicant is employed in an inspector capacity and include a detailed description of the job responsibilities.

510_2012 (Revised)



 

Employment Reference Form (ERF)  API 510, Pressure Vessel Inspector Certification Program Applicant’s Full Name:

VIJAYARAJ KUMAR

API ID (if known) Company: HARIKRISHNAN RAJAPPAN  Name of Supervisor

Title

Address

Telephone Number

Affirms that

Worked for  Name of Applicant

from

Company to

Beginning Date

Ending Date

SUPERVISORS: Please fill in the blanks below. Your signature on this page validates that while working for your company and during the period indicated above the applicant has acquired the following experience: This box must be compl eted. Please Please fill i n all that appli es for th e CURR CURRENT ENT employer.   Dates

Length of Experience Experience With This Employer

INSPECTION of Pressure Vessels

18-JULY-2008 17-JAN-2010 From ______________To__ ______________To___________________ _________________

01 YEARS 06 MONTHS

Design of Pressure Vessels

18-JAN-2010 17-JAN-2012 From _____________To___________________

02 YEARS

Construction of Pressure Vessels

18-J 18-JA ANN-2 2012 012 TILL TILL DA DATE TE From _____________To___________________

5 MONTHS

Operation of Pressure Vessels

From _____________To___________________

Repair of Pressure Vessels

From ______________To__ ______________To___________________ _________________

 Ac ti vity vi ty

 ALL  AL L A PPLICANTS MUST HAVE THE AREA BEL BELOW OW COMPLETED AND VALIDATED VALIDA TED HARIKRISHNAN RAJAPPAN SUPERVISOR’S NAME (PLEASE PRINT) __________________________________

 __________________________________________ _______________________ Supervisor's Signature Date  Subscribed and sworn to before me the ___________________ day of ________________, ______.

 Notary Signature My commission expires _________________________  Notary Public Notary or Company Stamp or Seal

510_2012 (Revised)



 

API 510 Test Registration Applicant’s Name: Exam ID

VIJAYARAJ KUMAR _________________________________________

(If previously assigned):

Examination Locations and Dates Please Ple ase indicate your pr efe eferred rred exam date and location l isted below. Jun e 6, 201 2012 2 (Applic ation Deadlin e – API must receive no l ater than March 21, 2 2012 012) 

September 26, 2012 (Application Deadline – API must receive no later than July 11, 2012 )

 Ap pl ic ati on dead li nes are fir f irm m — no exc ept eptio io ns w il l be b e made. mad e.

it io nal si ttin tt in g fee f ee wi ll be rrequ equ ir ed at th e Edmon Edm on to ton n l oc ati on in Ju ne & December Decem ber . *NOTE:  An add itio You will r eceive information, prio r to th e exam exam date, from ABSA / API, API, with payment instructio ns.  

North America:    Anchorage, AK

* Edmonton, A AB B (Canada)

Oklahoma City, City, OK

 Atlanta, GA

Houston, TX

Philadelphia, PA

Baton Rouge, LA

Los Angeles, CA

St. Paul, MN 

Corpus Christi, TX

Oakland, CA 

Other Locations:    Abu Dhabi, UAE UAE  Al-Khobar, Saudi Arabia Bogota, Colombia



Cairo, Egyp Egyptt

Kuala Lumpur, Malaysia

Singapore, Singapore

Chennai, India

Mumbai, India

United Kingdom (Contact API for city info)

Doha, Qatar

Port of Spain, Trinidad

If a location of your cho ice is not list ed above please contact API for more information. If you are testing at an API-approved special site, please include the location and/or group here:_________________________________________ City, Country

> > THIS FORM MAY MAY A LSO B BE E USED TO RESC RESCHEDULE HEDULE A TEST << If reschedul ing ing,, plea please se remember to inc lud lude e the rere-test test fee. 

510_2012 (Revised)



 

Inspector Certification Agreement - 1 (Effective on Date of Inspector’s Certification) Certification) This Agreement is between the American Petroleum Institute (hereinafter “API”), a corporation of the District of Columbia, having an office at 1220 L Street, N.W., Washington, D.C. 20005, and the Applicant (the “Inspector”), residing at the address noted below. Whereas, API’s Individual Certification Programs (“ICP”) certify inspectors and other technical personnel that meet the guidelines and requirements specified in the program. Whereas, Inspector desires to obtain certification under the API ICP program.  Now therefore, in consideration of the mutual mut ual covenants hereinafter stated, the parties agree as follows: 1.  Inspector agrees to comply with all of the program program policies and requirements. Inspector agrees and understands that API shall be the sole judge of whether the Inspector has the appropriate qualifications to become certified, remain certified, or to be recertified. 2.  The Inspector agrees not to make any misrepresentations concerning the Inspector’s certification status or the  program. The Inspector agrees not to perform any acts, which directly or indirectly assist a third-party in making any misrepresentation relating to the ICP program. 3.  The Inspector understands and agrees that the ICP Program is designed to assist users in identifying inspectors who have satisfied the minimum qualifications specified in the applicable industry standards and that API does not warrant or guarantee the competency competency of any inspector certified under this program. The inspector agrees not to mislead customers or the public about the scope and purpose of this program. 4.  The Inspector authorizes API to release information to regulatory agencies, current or potential employers, or other interested parties concerning the inspector’s certification status. API agrees to take reasonable measures to ensure that any information that is released is accurate. However, API does not warrant or guarantee the accuracy of any any information that is released and specifically disclaims any liability relating to the release of this data. 5.  The Inspector understands and agrees that the Inspector’s certification will not be renewed unless the inspector satisfies all of the program requirements for renewal and submits the appropriate recertification application and renewal fee to API within the time frame specified by API. 6.  Inspector understands and agrees that API may modify the requirements for an inspector to obtain, maintain, or renew the certification at any time. If API’s requirements are modified, API shall determine the date by which the new requirements become effective. Inspector agrees to comply with the modified requirements within the deadline specified by API. API agrees to attempt (but assumes no duty) to notify Inspector of significant changes to the  program by either giving notice: (1) at the Inspector’s last known address, or (2) the Inspector’s last l ast known e-mail address, or (3) by posting the changes on the API website. It is the responsibility of the Inspector to notify API of address changes. The failure of API to notify Inspector of a renewal date or modification of the program does not relieve the Inspector of the responsibility to file a timely renewal application or to comply with new certification requirements. It is the responsibility of the Inspector Inspector to obtain this information by contacting API or by checking the API website for updates. 7.  If any action or proceeding is brought by API to enforce, protect or establish any right or remedy with respect to this Agreement or with respect to the subject matter of this Agreement, API shall be entitled to recover reasonable attorney's fees and costs provided that it is the prevailing party. Inspector agrees to indemnify API for any losses or damages resulting from the breach of the terms of this Agreement by the Inspector. 8.  The Inspector agrees and understands that API may terminate an inspector’s certification if API determines that the inspector has: (1) made material errors, omissions, or misrepresentations on the application or in documents submitted to API, or (2) violated any terms or conditions of this Agreement or any ICP policies or requirements. API also may terminate the program at any time and for any reason deemed appropriate by API. Upon termination, with or without cause, of any rights or authority conferred by this Agreement, or upon expiration/termination of the Inspector’s certification, Inspector agrees to return all certification documents to API within 30 days. 9.  The Inspector shall not use any trademark of API or name of API including any abbreviation thereof, in any  publicity, advertising, or for other promotional purposes without the prior written wri tten approval of API.

510_2012 (Revised)

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10.  The Inspector agrees to comply strictly with all U.S. export laws relating to this program. The Inspector warrants that he is not located in, or under the control of, or a national or resident of any embargoed countries. 11.  This agreement shall not and is not intended to benefit or to grant any right or remedy to any person or entity that is not a party to this Agreement. 12.  This instrument contains the entire and and only agreement between between the parties. No oral statements or representations not herein contained shall have any force and effect. 13.  Paragraphs 2, 3, 4, 5, 6, 7, and 8 survive termination of this agreement. 14.  It is expressly understood between the parties hereto that no association, agency, apparent agency, employer/employee relationship, joint venture of anythe kind has as been created. Inspector agrees not to refer to himself as API’s agent norpartnership, refer to theor relationship between parties a joint venture or partnership or in any manner inconsistent with this Agreement. Inspector shall have no authority to act or contract on behalf of API. 15.  No waiver by API of any default, misrepresentation, or breach of warranty or covenant hereunder, regardless of whether intentional, shall be deemed to extend to any prior or subsequent default, misrepresentation, or breach of warranty or covenant hereunder or affect in any way any rights arising by virtue of any prior or subsequent such occurrence. 16.  API makes no express or implied warranties regarding the ICP program or potential benefits of the certification to the Inspector. 17.  The Inspector agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority in any way measured by this Agreement, or any portion of it, or any services related thereto. 18.  Inspector understands and agrees that Inspector is not granted any rights under the program or this Agreement until API has determined that thecertification Inspector hasshall satisfied all of theonprogram a Certificate to the Inspector. The Inspector’s be effective the daterequirements that is notedand onhas theissued Certificate and shall be effective for a period of three years unless terminated pursuant to the terms of this Agreement. 19.  This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia, USA, without regard to the rules regarding conflicts of law. The parties agree that any action, suit, or proceeding based upon any matter, claim, or controversy arising hereunder or relating hereto shall be brought exclusively in the federal or state courts located in District of Columbia, USA. The parties consent to the jurisdiction and venue of such courts, and waive any objections to the jurisdiction and venue thereof.

I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to comply with the conditions specified above.

VIJAYARAJ KUMAR Applicant’s name (please print) _____________________________ _______________ ______________  _____________  ______ ______________ _____________ _____________ _________ __ Signature of Applicant

E-mail: _________________________

______________ _________________ ___ Date

Applicant’s address: ______________________________________________  ______________________________________________  _________________________ _____________________ API Reviewer’s Initials: ____________

510_2012 (Revised)

11 

 

 

Inspector Application Agreement - 2 (for Initial and Renewal Certification) (Effective upon Receipt of Application)  The applicant agrees to the following conditions: 1.  API agrees to evaluate the applicant’s qualifications to determine if the Inspector satisfies the requirements of the ICP  program. Applicant understands and agrees that: (1) API will not issue an ICP certificate to the Applicant Appl icant unless API determines that an Applicant meets all of the requirements and Applicant has submitted the applicable fees and documentation within the specified time frame, and (2) API shall be the sole judge of whether the Applicant has the appropriate qualifications to become certified, remain certified, or be recertified. 2.  The Applicant agrees to pay the applicable fees, comply with all of the program requirements and submit any supplemental information or documents documents deemed necessary necessary by API to verify an applicant’s qualifications. Applicant understands and agrees that API does not represent or warrant that the submission of the fees and materials by the Applicant will result in the Applicant being certified under the program. 3.  Each new application remains valid for a period of 12 months from the date of receipt by API. API grants each applicant three consecutive attempts during the 12-month period to sit and pass the test, starting with the first exam administration the applicant registers for. Applicants must pass the exam within these three consecutive exam administrations. If an applicant fails to appear for the test, cancels his/her appearance and reschedules, or takes the exam and fails it, it will count as an official attempt. 4.  If the applicant does not obtain a certification within this period of time and still wishes to obtain the certification, they must start the application process again, including re-submission of a full fee and a complete new application. 5.  All requests for refunds must be submitted in writing by mail, e-mail or by fax to API no later than 6 months from the date payment was received by API. Requests for refunds received after this period cannot be fulfilled. 6.  An applicant is entitled to a full refund of the application fee, minus a processing fee, only if API receives the refund request prior to the exam application deadline. 7.  An applicant is entitled to a 50% refund of the application fee if the refund request is received by API within 6 months from the date payment was received by API and the candidate cancelled in advance of the examination date. 8.   No refunds will be made if an applicant has taken the test or did not show up without prior notice. 9.  For normal processing API must receive recertification applications prior to the current certification’s expiration date. Recertification applications must be mailed, as API requires the original of the notarized page. 10.  API may extend the certification term for 3 (three) months after the expiration date. Inspectors will remain authorized during that period of time. Recertification applications received by API within this extension term will be processed,  but a $150.00 late fee will be required. 11.  Inspectors who do not apply for recertification within three months after the current certification expiration date will be decertified. 12.  Circumstances such as heavy work schedule or work in other countries do not relieve the applicant of the responsibility to file a timely renewal application. 13.  Applicant understands and agrees that API may modify the requirements for an applicant to obtain, maintain, or renew the certification at any time. If API’s requirements are modified, API shall determine the date by which the new requirements become effective. Applicant agrees to comply with the modified requirements within the deadline specified by API. API agrees to attempt (but assumes assumes no duty) to notify Applicant of significant changes to the  program by either giving notice: (1) at the Applicant’s last known address, or (2) the Applicant’s last known e-mail address, or (3) by posting the changes on the API website. It is the responsibility of the Applicant to notify API of address changes. The failure of API to notify Applicant of a renewal date or modification of the program does not relieve the Applicant of the responsibility to file a timely renewal application or to comply with new certification requirements. It is the responsibility of the Applicant to obtain this information by contacting API or by checking the API website. 14.  The Applicant agrees to comply strictly with all U.S. export laws relating to this program. The Applicant warrants that he is not located in, or under the control of, or a national or resident of any embargoed countries. 510_2012 (Revised)

12 

 

 

15.  The Applicant agrees to pay all sales, use, property, excise, and other taxes now or hereafter imposed by any government body or authority based on in any way measured by this Agreement, or any portion or it, or any services related thereto. 16.  Applicant warrants and represents to all information that is being submitted pursuant to this is complete and accurate. Applicant understands that API is relying upon the accuracy of this information in evaluating the Inspector’s qualifications. Applicant agrees to indemnify API for any claims, losses, or damages damages resulting from the Applicant submitting inaccurate or misleading information.

I, the undersigned, certify that I have read and fully comprehend this form in its entirety and agree to abide by the policies and regulations specified above.

VIJAYARAJ KUMAR

Applicant’s name (please print) ____________________________ ____________________________

 _____________  ______ _____________ _____________ ______________ _________ __ Signature of Applicant

E-mail: ___________________________ ___________________________

_______ _____________ __________ ____ Date

API Reviewer’s Initials ________________

510_2012 (Revised)

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API 510 - PAYMENT INFORMATION VIJAYARAJ KUMAR Applicant’s Name: _________________________________________ Exam ID

(If previously assigned):

 API memb m emb er r ate appl ap pl ies to fu ll -ti me, non n on -co nt rac t empl em pl oy ees of o f API-mem A PI-member ber co mpani mp ani es.

 API Member  Mem ber  

Non Member  

$600.00   $600.00

$800.00  $800.00 

PAYMENT INSTRUCTIONS    





 



All payments must be made in United States currency. Checks must must be drawn on a U.S. bank. You are responsible for all taxes, banking or other service fees, including all applicable withholding taxes. Ap taxes. Appl pl icant ic ant ’s nam e(s) mus m us t b be e incl in cl ud ed o n tthe he chec c hec k. For payments by electronic tr transfer: ansfer: (1) you are responsible for all electronic transfer, A.C.H. and banking fees (be sure to add the fees to your payment); (2) for el electronic ectronic payments not drawn on a U.S. bank a fiftydollar ($50) handling fee must be added at the time payment is made. Please include a copy of the wire / electronic transaction. Ap transaction.  Appl pl ic icant ant ’s nam e(s) m mus us t b be e incl in cl ud ed on the transaction docu ment.

PAYING BY CREDIT CARD CAN EXPEDITE THE PROCESSING OF YOUR APPLICATION AND PAYMENT TO ENSURE YOUR PLACE IN THE EXAMINATION. Credit Card Type:



Visa

American Express

Card Number:

Expiration Date:

 Name as it appears on card Signature

MasterCard

_____________________________________________

_______________________________________

E-mail address to send receipt: Check

Initial Certification Fee Reschedule / Retest Fee ($150.00)  Late Penalties Bank Fee (if (if wired)

Wire Transfer to:

TOTAL SUBMITTED

TD Bank 1030 15th St NW Washington, DC 20005 USA  ABA Routing # 054001725 Credit to: American Petroleum Petroleum Institute  Account # 4251303172  4251303172  SWIFT: NRTHUS33

(Reference: Applicant’s Name and SS-2100-D9200-7110)

Your application will not be processed if this page is not completed.

510_2012 (Revised)

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API 510 Exam Administration -- Publications Effectivity Sheet FOR: June 6, 2012 2012 &  & September 26, 2012 2012   Listed below are the effective editions of the publications required for this examination on the date(s) shown above.      API Standar Stan dar d 510, Pressure Vessel Inspection Code: In-Service Inspection, Rating, Repair, and Alteration , 9th Edition, June 2006. IHS Product Code API CERT 510



   API Reco mmend mm end ed Practi Prac ti ce 571,  Damage Mechanisms Affecting Fixed Equipment in the Refining Industry, 1st Edition, December 2003. IHS product code: API CERT 510_571 ( includes only the portions listed below)



ATTENTION:   Only the following mechanisms to be included: Par. 4.2.3 – Temper Embrittlement 4.2.7 – Brittle Fracture 4.2.9 – Thermal Fatigue 4.2.14 – Erosion/Erosion-Corrosion 4.2.16 – Mechanical Failure 4.3.2 – Atmospheric Corrosion 4.3.3 – Corrosion Under Insulation (CUI) 4.3.4 – Cooling Water Corrosion 4.3.5 – Boiler Water Condensate Corrosion 4.3.10 – Caustic Corrosion 4.4.2 – Sulfidation 4.5.1 – Chloride Stress Corrosion Cracking (Cl-SCC) 4.5.2 – Corrosion Fatigue 4.5.3 – Caustic Stress Corrosion Cracking (Caustic Embrittlement) 5.1.2.3 – Wet H2S Damage (Blistering/HIC/SOHIC/SCC) 5.1.3.1 – High Temperature Hydrogen Attack (HTHA)

   API Reco mmend mm end ed Pr Pract act ice ic e 572, Inspection of Pressure Vessels, 3rd Edition, November 2009. Product Code API CERT 572



   API Reco mmend mm end ed Pr Pract act ice ic e 576, Inspection of Pressure-Relieving Devices, 3rd Edition, November 2009. Product Code API CERT 576 



   API Reco mm end ed Pr Pract act ic e 577 – Welding Inspection and Metallurgy, 1st Edition, October 2004. Product Code API CERT 577 



   Am  Ameri eri can Societ Soc iety yo off Mechan Mec han ic al Engi En gi neer s (A (ASME) SME),, Boiler  Boiler and Pressure Vessel Code, 2010 Edition  i.  Section V, Nondestructive Examination, Examination, Articles 1, 2, 6, 7 and 23 (Section SE-797 only))  ii.  Section VIII, Rules for Construction Construction of Pressure Vesse Vessels, ls, Division 1; Introduction Introduction (U), U UG, G, UW, UCS, UHT, UHT,



 Appendices 1-4, 6, 8 and 12

iii.  Section IX, Welding and Brazing Qualifications, Welding only  Product Code for the ASME package API CERT 510 ASME. Package includes only the above excerpts necessary for the exam.

 API and ASME pu bl icati ic ati on s can c an b e or order der ed thr t hr ou gh either eit her : ); phone 1-800-854-7179 >> IHS Documents (www.global.ihs.com (www.global.ihs.com);

or    >> TechStreet (www.techstreet.com www.techstreet.com); ); phone 1-800-699-9277  API members are eligible for a 30% discount on all API documents; exam candidates are eligible for a 20% discount on all API documents. When calling to order, please identify yourself as an exam candidate and/or API member. Prices quoted will reflect the applicable applicable discou nts.  nts.   No discounts will be made for ASM ASME E documents.

Note: API and ASME publ ications are copyr ighted material. material. Photocop ies of API API and ASME publ ications are not permitted. Documents PRINT PRINTED ED from licensed CD-RO CD-ROMs Ms are allowed. Be sure to check yo ur CD-RO CD-ROM M against against th e editions n oted on this s heet. 510_2012 (Revised)

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CHECKLIST 1.

All pages of the application comp leted



2.

Valid Valid e-mail e-mail address incl uded so we can contact you



3.

All copies of dipl omas attached



4.

ERF ERF has a notary or company stamp



5.

Employment letter attached if necessary



6.

BOTH Inspector Agreement forms sign ed



7.

Certifi Certifi cation Fee Fee (payment (payment page fill ed in comp letely)



8.

Copy of transaction docu mentation if paying by wire



9.

Copy of compl eted application made made for your records

MAIL ORIGINAL A PPLICATION PPLICATION TO:  API Individual Certification Programs 1220 L Street, NW Washing ton DC 2000 20005 5 (Phone: 202-682-8064) Please include candidate’s name(s) on all payments.

IF PAYING BY CHECK OR MONEY ORDER, MAIL APPLICATION TO:  API Individual Certification Programs P.O. Box 1425 Merrifield, VA 22116 

TO SEND CHECKS BY COURIER, PLEASE ADDRESS PACKAGE TO:  API  Attn  At tn:: Joh J oh n Ro Rober ber ts on 1220 L Street, NW Washingt on, DC 20005 Phon e 202-682-8064 202-682-8064

510_2012 (Revised)

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