TÜV Rheinland Functional Safety ProgramTÜV Rheinland FS Expert Certification Note: Please fill in below table with due diligence. Thank you!

First Name

Family Name

Email Address

Company Name (full name as registered)

Legal form of company (Ltd., plc., Inc. etc.)

Invoice address of company

Street, Number

District

ZIP Code

City

Mandatory requirement:

For companies in EEC Countries: VAT ID / Registration No.

(available at your Finance or Legal Department)

For companies in Non-EEC Countries:

Only if your company is located in one of these countries: Algeria, Argentina, Australia, India, Indonesia, South Korea, Taiwan, Thailand, Tunisia

Please send us a Copy of Business Registration Certificate

Signed & stamped by local authority such as Chamber of Commerce (please forward document in pdf-format; available at your Finance or Legal Department.)

I hereby confirm that I wish to apply for TÜV Rheinland FS Expert

certification.

I have attached all necessary application documents.

I have indicated the VAT ID no. (EEC).

I have attached the Business Registration Certificate of my company as

copy (Non-EEC).

Date / Signature

TÜV Rheinland Industrie Service GmbH Am Grauen Stein Automation and Functional Safety 51105 Cologne (Köln) - Germany

TÜV Rheinland Functional Safety Program

Document Description

1 Curriculum Vitae Please send us your detailed CV incl. following information:

Photography

Name

Title

Education

Engineering degree or other degree

Work Experience and responsibilities of employments in the past 10 – 15 years

Description of areas of specialization

Description of specific experiences and expertise in Functional Safety

Publications and conference presentations, experiences as trainer

Affiliation in related committees, interest groups etc.

2 Degree Please send us a copy of your Master’s/ Bachelor’s (Dipl.) degree in Engineering (or any

other technical area) or copy of any other degree.

3 References Please send us 2 reference letters in written form, e.g. as business letter or statement

written on official company stationery: From companies involved in Functional Safety

(manufacturers, system integrators etc.)

Stating reason of cooperation or experience with applicant

Indicating approx. time frame of cooperation

4 Case Studies Please send us a synopsis of 2 case studies incl. the following information:

Purpose of case study or problem statement

Reference to special application area e.g. Safety Instrumented Systems, System

Hard-/Software Design etc.

Study Methods

Details of study

Results of study

Summary of case study

Glossary and References

For application to become a TÜV Rheinland FS Expert the following documents have to be sent in electronic form to: veronica.gras@de.tuv.com