EXAMINATION ENTRY APPLICATION

ELECTRICAL W ORKERS
REGISTRATION BO ARD

Please see the back of the form for additional information.

Please print clearly in black or blue pen and complete all required sections of the form.

EW Number
Candidate Code:

Personal details
Last Name

Email

First Name

Street Address

Middle Name

Preferred Name

Date of Birth

Home Phone

Postcode

(if different)

Mobile

Postcode

Postal Address

Work

Examination you are sitting

Electrical Inspector Theory

Electrical Installer Theory

Plumber and/or Gasfitter Written

Electrician Theory

Electrical Appliance Serviceperson Written

Electrical Appliance Serviceperson (Endorsed)

Electrician Regulations

Electrical Service Technician Written

Examination Information
Examination Centre
Training Provider
Examination Date
This application is

/
on time

/
late (less than 14 days before the above date)

I have met the eligibility criteria as stated in the overleaf:

Yes

No

Payment for Examination (see overleaf for fee schedule)

Payments must be made to the exam centre and NOT to the EWRB. (Refer to overleaf for fee schedule and payment details.)
The fee for this examination is $85.00.
I have made my payment by:
Credit card (Credit card information completed, see overleaf)

NZ Cheque made out to your exam centre

Declaration
I declare the information I have given is correct. I am aware that passing this examination does NOT entitle me to carry out prescribed electrical work for which
electrical registration is required. I agree to the release of my results to my teaching institute/provider or examination centre and for the purpose of receiving awards.

Signature

VER 12/12/14

Date

SAFETY | COMPETENCY | COMPLIANCE

3.2

Information for Candidates

Fees

Payment of fees

The total fee for examination entry includes the examination fee of $85.00,
the sitting fee prescribed by your examination centre, and a late fee of $85.00
if applicable. Contact your examination centre for their required sitting fee.

Payment must accompany each application.

Conditions of Eligibility
To enter a written examination you must have completed a tuition course
with an approved training provider.

Examination Syllabus
Examination subject matter for this examination is listed on the website
www.ewrb.govt.nz

Closing date
This examination entry form and the statutory fee must be paid to the exam
centre 10 working days before the examination date.

To work out your total examination entry fee, add the sitting fee to the
examination fee and include the late fee of $85.00 (if applying late) for the
total fee.

Examination Fee
Sitting Fee
Late Fee (if applicable)
Total

Late Entry Fees

Late entries will be accepted up to 5 days prior to the examination date.
Late entries incur an additional charge of $85.00 (incl GST).

Forfeit of Fees
Fees will be forfeited if you do not attend or are absent from the exam and a
satisfactory explanation is not provided to the Board.

Checklist
fees paid in full
completion of prescribed tuition course with an approved training provider

Credit Card information

Type

Full Name of Cardholder

MasterCard

Visa

Signature of Cardholder

Credit Card number

Expiry Date
/

Amex

Amount

Please return this form with payment to:

Your training provider (NOT to the EWRB)

For more help, call our helpline on 0800 661 000 between 8 am and 5 pm Monday to Friday.

Privacy Notice: Any personal information submitted on this application will be kept and maintained by the Electrical Workers Licencing Group (the EWLG) in accordance with the New Zealand
Privacy Act 1993. Personal information submitted will be used by the EWLG for determining whether applications for registration as an electrical worker or practicing licences may be granted,
and for the maintenance and administration of the Electrical Workers Register. You may request access to see any information held about you and where that information is inaccurate, ask for it
to be corrected.