Name of Applicant
FORM PEB-1
PROFESSIONAL ENGINEERS BOARD
COMMONWEALTH OF THE BAHAMAS
PHOTO (Please sign back of
photo)
APPLICATION FOR REGISTRATION AS A PROFESSIONAL
ENGINEER
Applicants are required to read the Professional Engineers Act 2004 as
amended. These documents are available on the PEB website -
www.pebahamas.org
Attach copy of ID pages
of passport
Form PEB-1 and supporting documentation to be submitted in triplicate
NAME OF APPLICANT:
Last
First
Middle
FORM PEB-1: To be completed by all persons applying for registration as a Professional
Engineer.
Kindly tick whether you are applying under Section 9(2)(a)
, 9(2)(d)
of the Act or
Section 10
thereof respecting temporary registration and submit the required documents for
the relevant parts as provided for hereunder.
PART-1 CATEGORIES OF ENGINEERING AND GENERAL INFORMATION:
Please indicate the discipline(s) of engineering in which you are seeking registration as
categorized in the First Schedule of the Professional Engineers Act.
Civil
Structural
Agricultural
Industrial
Mechanical
Aeronautical
Marine
Nationality
Passport No.
Home Address:
Box/Zip
Country
Business Address:
P.O. Box
Country
Email Address:
Electrical
Building Services
Chemical
Geotechnical
Environmental
Date of Birth
NIB/National Identification No.
City:
Island/State/Province
Telephone:
Mobile:
City:
Island/State/Province
Telephone:
Fax:
Have you ever changed your name through marriage, deed poll or court action? Yes
No
If yes list maiden or previous name and date of change below and attach relevant documents as
necessary.
Have you previously made application to this Board for Registration? Yes
No
If yes list last date:
Please indicate any special testing requirements due to disability or religious conflicts.
Form PEB-1
Applicants Initials
Page 1
Name of Applicant
PART-2: GENERAL EDUCATION
From
Month
Year
To
Month Year
Name of Educational
Institution
Certificates Obtained
PART-3: ENGINEERING EDUCATION
From
Month
Year
To
Month Year
3.1
College or University
Qualifications Obtained
The original or notarized copy of degree(s) or diploma(s) etc. shall be hand-delivered to the
Registrar for verification or via registered mail or courier. Originals shall be promptly returned.
Form PEB-1
Applicants Initials
Page 2
Name of Applicant
PART- 4 PROFESSIONAL EXPERIENCE
Name of Organization and
Particulars of Training
4.1
From
Month Year
To
Month Year
Verifying
Intitials
4.1 Applicants under Section 9(2)(a) of the Act are required to provide verifying initials
4.2 Applicants under Sections 9(2)(a) are to attach a Work Experience History Report of
at least 1,000 words of the applicants work experience which would demonstrate
proficiency in the design and execution of engineering works against which the Applicant will
be examined.
4.3 Applicants under Section 9(2)(a) of the Act are required to have a minimum of 4-years
relevant post graduate experience.
.
Form PEB-1
Applicants Initials
Page 3
Name of Applicant
PART-5: DETAILS OF PROFESSIONAL ENGINEERING REGISTRATION
(Original or notarized copy of certificates must be presented for verification). Applicants
applying under Section 9(2)(d) are to provide proof of current registration.
Name Of Registering
Organization/Board
Registration
Number
Date
Registered
Discipline
Examined
Status
Active/
Inactive
Have you ever had any disciplinary action brought against you resulting in a fine,
reprimand or revocation of engineering license in any jurisdiction?
Yes
No
Have you ever been convicted of any criminal offence in The Bahamas or elsewhere?
Yes
No
Have you ever been denied the right to take an engineering examination in any
country?
Yes
No
Have you ever been refused an Engineering license or the renewal thereof?
Yes
No
(If any of these questions are answered in the affirmative please provide complete
details on a separate sheet)
Form PEB-1
Applicants Initials
Page 4
Name of Applicant
PART-6: MEMBERSHIP IN ENGINEERING ORGANIZATION/ASSOCIATION
(Original or notarized copy of certificates must be presented for verification)
Name of Engineering
Organization/Association
Class of
Membership
Date of
Election
Professional Papers
Presented
Status
Active/
Inactive
PART 7 ENGINEERING REFERENCES
7.1 Applicants under Section 9(2)(a) are required to indicate the names and addresses of at
least three (3) engineering references (all of whom must be currently registered by a legally
empowered engineering authority recognized by the Board).
Name of Referee
Name of Professional
Affiliation
Membership
Number
Designation
(e.g. PE,
CEng, PEng)
Form PEB-1
Applicants Initials
Page 5
Name of Applicant
NOTE:
THIS DOCUMENT MUST BE NOTARIZED
The undersigned hereby makes application for Professional Engineering
Registration and affirms that he has read the Professional Engineers Act as
amended, the Regulations, the Code of Professional Conduct; and that all
statements and answers contained herein are true and correct. Any willful
falsification of any information contained in this application or attached
documents are grounds for disqualification.
Applicants Signature:..
Date..
Acknowledged Before Me______________________
This ___________ Day Of____________, 2_______
My Commission Expires_______________________
Number ________________
Form PEB-1
Applicants Initials
Page 6
Name of Applicant
PROFESSIONAL ENGINEERS BOARD
P.O. Box N-3 81 7
Nassau, Bahamas
Part-8: Engineering Reference Reply Form
APPLICANT INFORMATION
Name of Applicant:
Last
First
Middle
Date of Birth
P.O. Box/Postal Code
Address of Applicant:
Telephone:
Street
City
Email:
Island/State/Province
Country
REFERENCE INFORMATION
Name of Reference:
Last
Address of Reference:
Street
City
First
Middle
P.O. Box/Postal Code
Telephone:
Email:
Island/State/Province
Country
Indicate date document was forwarded to reference:
[NOTE: DO NOT INITIATE REFERENCE DOCUMENTS UNTIL FILING APPLICATION]
I have given your name as reference and have submitted to the Professional Engineers Board a
signed Certification of Release Statement authorizing "any individual, company or institution with
whom I have been associated with, to furnish the Professional Engineers Board with any information
concerning my qualifications for professional registration in the Bahamas which they have on record or
otherwise, and do hereby release the individual, company or institution and all individuals connected
therewith from all liability for any damage whatsoever incurred by me as a result of their furnishing such
information." Will you kindly furnish from your company records, the information requested below
and forward the completed document directly to the Professional Engineer's Board.
___________________________________________________
Applicants Signature
________________________________________
Date this Engineering Reference Reply Form forwarded to Reference
Form PEB-1
Applicants Initials
Page 7
Name of Applicant
Reference Initials: _________
TO BE COMPLETED BY REFERENCE
1.The above noted applicant is or was employed with this company from
______________________ to __________________
2. The
applicant has worked with me/for me from ___________ to
____________.
3. From
my personal knowledge the applicant has been engaged in
engineering for________________years.
4. From
my personal knowledge the applicant has been in an increasing
level of responsibility in engineering for __________ years.
5. Please
comment on the applicant's engineering work as indicated in Nos. 3
and 4 above for the stated times.
A.
Experience:
B.
Ability:
C.
Competency:
D.
Character:
Form PEB-1
Applicants Initials
Page 8
Name of Applicant
Reference Initials: _________
To the best of my knowledge, the above is true and correct. Please indicate
your status below.
__________________
Name of Reference
________________________
Signature
__________
Initials
_________________________________
Title/Position
_________________________
Professional Designation
_________________________
Registration (Location)
______________________
Date
Seal:
Form PEB-1
Applicants Initials
Page 9
Name of Applicant
Application Checklist
1.
2.
Form PEB-1 and all attachments are to be submitted in triplicate
Form PEB-2 to also be completed by persons applying for temporary
registration. The Form and all attachments are to be submitted in
triplicate
3.
Read the Professional Engineers Act 2004 and the 2009 Amendment
4.
Forms PEB-1 and PEB-2 may be completed electronically then printed
for signature and notarization
5.
Check box to indicate appropriate Section of Act under which
application is submitted
6.
Check the discipline(s) for which the applicant is seeking registration
7.
Attach a copy of information pages in passport and NIB Card, bring
originals with you when submitting the application
8.
Have copies of all certificates degree/diplomas, professional
membership certificates notarized or bring the originals with you when
submitting the application.
9.
Applicants under Sections 9(2)(a) must include the names and address of
at least three (3) engineering references (all of whom must be currently
registered by a legally empowered engineering authority recognized by the
Board).
10. Applicants under Sections 9(2)(a) are to attach a Work Experience
History Report of at least 1,000 words of the applicants work
experience which would demonstrate proficiency in the design and
execution of engineering works.
11.
Forms PEB-1 and PEB-2 and attachments to be notarized by a notary
public in the Commonwealth of the Bahamas
12.
All fees are to be paid by cheque (cash will not be accepted). Fees
are to be paid in Bahamian Dollars and are non-refundable. Only the
relevant application fee is to be submitted with Forms PEB-1 and PEB-2.
Applicants will be advised at the appropriate time for the payment of
other fees examination & registration.
Form PEB-1
Applicants Initials
Page 10
Name of Applicant
APPLICABLE FEES
Application Fee:
B$200.00
NCEES Examination Fee:
B$375.00
Registration Fee First Discipline:
B$200.00
Registration Fee second and
all subsequent disciplines:
B$100.00 for each discipline
Temporary Application Fee:
B$750.00
Temporary Registration Fee:
B$750.00
Temporary Registration Fee second
And all subsequent disciplines:
B$375.00
Annual Registration Renewal Fee
B$200.00
Duplicate Certificate:
B$100.00
Delinquency Fee:
B$200 for each delinquent year
Form PEB-1
Applicants Initials
Page 11
