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: firstname.lastname@example.org. 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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