HRVATSKA KOMORA INŽENJERA STROJARSTVA Ulica grada Vukovara 271 CROATIAN CHAMBER OF MECHANICAL ENGINEERS CROATIA - 10 000 Zagreb EIN: 2539071 Tel. +385 (1) 7775-570 VAT No: 26023027358 Fax. +385 (1) 7775-574 Web: www.hkis.hr info@hkis.hr DECLARATION OF FOREIGN PERSON AUTHORISED FOR THE REGULATED MECHANICAL ENGINEERING PROFESSION IN THE REPUBLIC OF CROATIA Form 22 FILLED OUT BY THE CROATIAN CHAMBER OF MECHANICAL ENGINEERS SECRETARIAT Date received: CLASS: CLASS: FILE No: 503 - - - FILE No: 503 - - - Issue date: 1. THE DECLARATION IS MADE FOR (please check): The first performance of the regulated mechanical engineering profession in the Republic of Croatia 2. PERSONAL INFORMATION: FIRST NAME: LAST NAME: AT - Austria BE - Belgium BG - Bulgaria CY - Cyprus CZ Czech Republic DK - Denmark EE - Estonia FI - Finland FR - France GR Greece IE - Ireland IS - Iceland IT - Italy LV - Latvia LI - Liechtenstein LT - Lithuania LU - Luxembourg HU - Hungary MT - Malta NL - Netherlands NO - Norway DE - Germany PL - Poland PT - Portugal RO - Romania SK Slovakia SI Slovenia ES - Spain SE - Sweden GB Great Britain CH - Switzerland HR - Croatia Other (please specify): Personal document (please check): Identity card Passport Certificate of citizenship Sex: Male Female VAT No.: Date of birth: Country: Personal document No.: Date of expiry (MM/YYYY): Place of issue: Country of issue: Place: Citizenship: Personal taxpayer number (TIN / OIB / MBG / ID No.) Personal contact data in the home country (mandatory): Address (street and number): Postal code City: Country : 1
Contact data in the Republic of Croatia (optional): Address (street and number): Postal code PERSONAL CONTACT DATA: City: Mobile (with dialling Country : CONTACT DATA IN THE COMPANY OF EMPLOYMENT: Company name: CONTACT PERSON First and last name: Mobile (with dialling Mobile (with dialling Remark (company name): 3. REGULATED PROFESSION OR ACTIVITY Name of professional qualification / regulated profession in the country of establishment: I hereby apply for the recognition of my qualification to pursue the following regulated profession from the Register of Regulated Professions or Professional Activities in the Republic of Croatia: (Specify in detail the name and number from the Register of Regulated Professions or Professional Activities in the Republic of Croatia) Are you qualified to pursue the abovementioned regulated profession in your home country? (please check) YES NO (If YES, please specify a document enclosed herewith proving the qualification and the name of the institution that issued it) Is this profession regulated in your home country? (please check) YES NO (If YES, please state the full name of the authority regulating the profession) Is there a formally organized education for performing the abovementioned profession in your home country that qualifies you to pursue this profession? (please check) Name of regulated profession you will be pursuing in the Republic of Croatia: YES NO Have you been authorised to pursue the regulated profession in another EU Member State? (please check) YES NO (If YES, please name the state and the full name of the authority that issued the authorization (evidence has to be enclosed)) 4. EDUCATION AND TRAINING DATA Name of educational institution (in native language): Address and country of educational institution: Professional title in native language: Duration of education and training: 2
Enrolment date: Graduation date: Education level acc. to EQF ECTS credits acquired: (European Qualifications Framework): Certificate of eligibility to pursue the regulated profession issued by the competent authority of the country (please enclose proof thereof) Other evidence of formal education (please enclose): YES NO Proof of contents and course of training fields and subjects (please enclose): YES NO Proof of other qualifications (please specify which and enclose): YES NO YES NO Qualifications according to EQF European Qualifications Framework (please check): primary education Level 1 (8 years) Level 1 + vocational training for simple jobs Level 2 vocational education Level 3 (1-2 years) general secondary education Level 4 (4 years) professional higher education studies Level 5 (120 to 179 ECTS credits /more than 2, less than 3 years) undergraduate university studies and undergraduate professional studies Level 6 (180 to 240 ECTS credits / 3 4 years) graduate university studies, specialist graduate professional studies and post-master specialist university studies Level 7 (1-2 years) postgraduate research Master of Science Studies Level 8 (2 years) postgraduate university doctoral studies Level 8 (at least 3 years) 5. CROATIAN LANGUAGE PROFICIENCY Knowledge of the Croatian language (please check) YES NO If YES, please indicate the level A B C Language skill levels: A beginner/breakthrough; B independent user; C proficient user. If you have NO knowledge of the Croatian language, please specify the person whose translation services you will be using in pursuing the regulated mechanical engineering profession in the Republic of Croatia (Statement has to be enclosed)! First and last name: Mobile (with dialling Company name: 6. PROFESSIONAL EXPERIENCE (professional experience in pursuing the regulated profession): Self-employed: YES NO or Employee: YES NO From (date): To (date): Company full name: Job title: Job description: 7. LEGAL ESTABLISHMENT IN ONE OR MORE STATES: Are you legally established in a EU Member State to pursue the profession under item 3.1? YES NO If YES, which is the Member State of establishment (name of the state)? If NOT, please explain: 3
Is the profession regulated in the Member State of establishment? (please check): YES NO Remark: Are you a member of any professional association or any similar organization? (please check): YES NO If YES, please specify full name and information on the association / organization and the registration number: Does the activity need to be approved by the relevant authority in the state of establishment? (please check): YES NO If YES, please specify the data on the relevant authority: 8. PROFESSIONAL LIABILITY INSURANCE: Are you covered by an insurance policy or any other personal / collective insurance against professional? Liability for pursuing the profession under Item 3? (please check): IF NO, YOU HAVE TO SUBMITT THE PROFESSIONAL LIABILITY INSURANCE POLICY CONCLUDED IN YOUR NAME WITH MINIMUM COVERAGE OF HRK 1,000,000 PRIOR TO TAKING OVER OF THE CERTIFICATE OF ENTRY INTO THE REGISTER. Insurance company: Policy No. /expiry date / insured perils: Remark: YES NO 9. PLEASE ELABORATE ON THE PROFESSION YOU WISH TO PURSUE IN THE REPUBLIC OF CROATIA (description and type of work you wish to pursue): The work I wish to pursue in the Republic of Croatia (please check): design engineer construction supervisor construction engineer site (discipline) engineer 10. POWER OF ATTORNEY: First and last name of the representative: Telephone /mobile number (with dialling By signing this Declaration, I authorise the below named person as my representative to receive the documents issued by the Chamber regarding my Application! 4
BY SIGNING THIS DECLARATION: 1. I SOLEMNLY DECLARE, UNDER PENALTY OF PERJURY, THAT THE INFORMATION HEREIN CONTAINED, AND THE DOCUMENTS AND ENCLOSURES HERETO ARE TRUE AND CORRECT. 2. I AGREE THAT MY PERSONAL DATA MAY BE COLLECTED, PROCESSED AND KEPT BY THE CROATIAN CHAMBER OF MECHANCIAL ENGINEERS IN ACCORDANCE WITH THE PROVISIONS OF THE PERSONAL DATA PROTECTION ACT. 3. I AM FAMILIAR WITH LAWS AND REGULATIONS GOVERNING THE ACTIVITIES IN THE FIELD OF PHYSICAL PLANNING AND CONSTRUCTION, AND WITH THE STATUTE AND OTHER ACTS OF THE CROATIAN CHAMBER OF MECHANICAL ENGINEERS. 4. I ACCEPT THE COMMITMENT TO CONDUCT MY ACTIVITIES PURSUANT TO THE AUTHORITIES STIPULATED BY THE LAW, CHAMBER' INTERNAL RULES AND REGULATIONS, SPECIAL LAWS AND REGULATIONS ENSUING FROM SUCH LAWS. 5. I AGREE THAT MY PROFESSIONAL DATA FROM THE DIRECTORY OF THE CROATIAN CHAMBER OF MECHANICAL ENGINEERS BE MADE PUBLICALLY AVAILABLE. Place and date: Signature: Documentation enclosures are submitted in certified translation into the Croatian language accompanied by certified copies of the original documents: proof of citizenship - a copy of personal identification document (ID card and/or passport) or certificate of citizenship university diploma / secondary school leaving certificate and diploma / certificate supplement (diploma/secondary school supplement with Performance Record) authorisation for pursuing of activities of the design engineer and/or professional construction supervisor, construction engineer and site (discipline) engineer as a responsible person in the home country issued by the authority issuing a proof of no conviction - an evidence that the applicant has not been sanctioned with a measure of temporary and/or permanent ban to perform the regulated profession by the relevant authority in the home country issued by the relevant authority in the home country issuing the authorisations for pursuing of the professional activity (not older than 6 months) evidence of valid professional liability insurance with coverage of minimum HRK 1,000,000 (approx. EUR 135,000) original and/or copy of the insurance policy issued in the name and valid in the territory of the Republic of Croatia and/or EU proof/ evidence on professional competences (experience in the profession)- in more detail for the last 2 years (Enclosure 1) statement on the Croatian language proficiency and/or statement on use of translation services (acc. to Item 5. above) certificated issued by an employer on employment in the EEA contracting state namely certificate on legal establishment in the EEA contracting state (employment date, job title, jobs performed, etc. receipt on payment of annual membership fees in the amount of HRK 1,800.00. An evidence of payment of the Chamber procedure fees of HRK 2,000.00 (for physical and legal persons from the Republic of Croatia the fee is increased by VAT). The payments made by legal or physical persons from the EU Member States or third countries are not increased by VAT, thus it is necessary to submit the payer s VAT identification number used for deliveries or acquisition of goods and services. PAYER VAT Identification Number (mandatory) REMARK: - The VAT is not payable if the service user is a taxable person in the EU Member States or third countries. - If the service user is a non-taxable person (physical person) in the EU Member States or third countries, the VAT on the services is paid at the principal place of business of the taxable person who provided the services, or the fees are increased by the amount of VAT. - All documents should be submitted in certified translations into the Croatian language and Latin alphabet accompanied by certified copies of the original documents. Expressions that are in this application use for people in the masculine gender are neutral and apply to male and female persons. 5
UPUTE ZA UPLATU (PAYMENT INSTRUCTIONS) Primatelj (Payee): HRVATSKA KOMORA INŽENJERA STROJARSTVA Model (Payment 00 Broj računa (Account No.): HR5623600001102094156 For international payments SWIFT: ZABAHR2X, Zagrebačka banka Poziv na broj odobrenja (Remittance advice): POREZNI BROJ UPLATITELJA (VAT Identification number of the payer) Opis plaćanja (Description): ČLANARINA I NAKNADA ZA POSTUPAK PROVJERE INOZEMNE STRUČNE KVALIFIKACIJE IME I PREZIME PODNOSITELJA IZJAVE (MEMBERSHIP FEE AND FEES FOR CHAMBER PROCEDURE - APPLICANT S FIRST AND LAST NAME) 6
ENCLOSURE 1: PROFESSIONAL COMPETENCES OF THE APPLICANT First name: Last name: Professional title acquired: Remark: Please enter only the professional engagements on a project or part of a project you have personally carried out (extend the table if necessary) during the previous 2 years No. as a responsible design engineer (P) and/or as construction supervisor (N) and/or as construction engineer (VG) and/or site (discipline) engineer (VR) Duration of professional engagement from MM/yyyy to MM/yyyy Name of project or part of project on which you have been engaged in your professional capacity Brief description of the professional engagement and Applicant s position Type of work (please enter) DESIGN ENGINEER (P) SUPERVIOR (N) CONSTRUCTION ENGINEER (VG) SITE (DISCIPLINE) ENGINEER (VR) 1. 2. 3. 4. 5. 6. 7. 8. 9. Place and date: Signature 7