Request for Exam Re-mark




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Request for Exam Re-mark

AB-242 2015-03



Applicants Information:

File No.:      






Name of Applicant:

     

     

 

Date of Birth:

     




(Last Name)

(First Name)

(Middle Initial)




(yyyy/mm/dd)




Mailing Address:      

     

  

     




(Apt./Street)

(City)

(Prov)

(Postal Code)




Phone No.:

     

Cell No.:

     







(Home)













E Mail Address:      




Please indicate the exam that was written:









Part A

Part B










Paper

Paper




Class




1

2

3

4

1

2

3

4

Special Oilwell (SOW) 

1st

















Special Boiler 

2nd



















Fired Process Heater 

3rd





















IPV 

4th























IBPV 

5th
























Steam Traction Engine 




Exam Date:      


Exam Location:      




Applicants Signature: Date:      



(yyyy/mm/dd)
*Note: You cannot reapply to write this same examination until after the remark has been completed.




PAYMENT INFORMATION

Cheque payable to:

ABSA, the pressure equipment safety authority


9410 – 20th Avenue

Edmonton, AB T6N 0A4

Phone (780) 437-9100 Fax (780) 437-7787

Exams Toll Free Line - 1-888-454-3926



www.absa.ca
Email: exams@absa.ca

Amount: $147.00

 MC  VISA  CASH  CHEQUE

Cardholder Name:      










Card Number:      







Expiry Date:      







Signature:

















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