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									                                                   European Certification
                                                 for Logistics Professionals


                                                      Application for exams


A) Identification data of the applicant
Name                                           Surname                                     Title                        DOB




B) Address of applicant :
Town                                           Street and no                               Country                      ZIP




C) Contact:
Phone:                                         Email                                                     Fax




D) Corresponding address (if different from above)
Town                                           Street and no                               Country                      ZIP




E) Choice of certificaton level (EJlog / ESlog) and modules
            EJlog (junior)                                                              ESlog (senior)
            2 compulsory and 2 free choice                                              3 compulsory and 3 free choice
           Basic Supply Chain Concepts                                                Basic Supply Chain Concepts
           Core Management Skills                                                     Core Management Skills
               Inventory Management                                                        Inventory Management
               Warehouse Management                                                        Warehouse Management
               Transport Management                                                        Transport Management
               Production Planning                                                         Production Planning
               Sourcing and Procurement                                                    Sourcing and Procurement
                                                                                       Supply Chain Flow and Network Management


I agree to enrol for the date of certificate exams and claim that I have carefully read and abide to the participation terms and conditions valid
in view of the ECBL standards.

I also commit myself to pay the certification exams fee of 6.000 CZK for class EJlog and 9.000 CZK for class ESlog one week prior to the date of
the certification exams at the latest. I bear in mind that participation in the certificate exams in only possible when these conditions are met.




Place                                          Date                                        Applicant's signature




Please mail the filled in application form to: Czech Logistics Association o.s., Institut J. Pernera, Pod Vytopnou 367, 186 00 Prague 8 or use the e-
mail address: sekretariat@czech-logistics.eu.
We will confirm receiving your application on the address provided by you in the application form.
Either once your fee payment is transferred to the ČLA account CSOB 163156712/0300 or once we receive a copy of confirmation of the
payment, you will be asked to participate in the certificate exams.

								
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