SANIRE
South African National Institute of Rock Engineering
P O Box 688, Virginia, 9430, South Africa,, Tel. +27 (0) 57 904-6066, Fax. +27 (0) 86 718-6082,
CHAMBER OF MINES CERTIFICATE IN STRATA CONTROL
APPLICATION FOR PRACTICAL ASSESSMENT

(Note: Candidates may only attempt one practical assessment in-between theory examinations
Practical assessments are hosted in-house by each individual mining group.)
YOUR DETAILS
THE * (asterisk) INDICATES COMPULSARY FIELDS
Date of Application *
UNISA Examination Number
Full Names & Surname *
ID Number *
Tel No. *
Cel No. *
Fax No. *
Email address *
Postal address *
EMPLOYER DETAILS
Name of Employer *
Address of Employer *
Shaft/Division *
Tel No. *
Fax No. *
YOUR QUALIFICATIONS
Standard Passed at School *
Other Qualifications * (Tech/University)
TO BE COMPLETED BY APPLICANT
Assessment for *
Coal
Massive
Open Pit
Passed Theory * YES
NO
CONFIRM AND SEND YOUR APPLICATION
By submitting this form, I, the applicant, confirm that the information supplied herewith is correct.