Nombre del Candidato:

API 570 - Solicitud de Pago La tasa para miembro API aplica para el personal en relación de dependencia de empresas miembro API, no para personal contratado/subcontratado.

Miembro API No Miembro

U$S 600.00 U$S 800.00

INSTRUCCIONES DE PAGO

• Todos los pagos deben realizarse en TEDUC. Incluir u$s110 por gastos administrativos y de gestión. Valor neto a transferir: Miembro API u$s710/ No Miembro u$s910. Para re-inscripción incluir u$s30 (Neto u$s180). En todos los casos se deberá incluir el IVA.

• Los pagos deben ser realizados antes de la fecha límite de inscripción. • Cheques deben estar emitidos a la orden de TEDUC S.R.L. Usted será responsable por el pago de impuestos. • Transferencia Bancaria: Debe ser realizada a la cuenta indicada y Usted será responsable por los gatos de

transferencia.

• Complete y entregue la solicitud de pago. Envíe comprobante de pago en case de transferencia bancaria. INDIQUE FORMA DE PAGO

Pago por Inscripción

Pago por Re-inscripción (U$S 180 +IVA)

CHEQUE/EFECTIVO

Nro. Cheque:

Bco.:

TRANSFERENCIA Datos para transferencia: Razón social: TEDUC S.R.L Cuit: 30-70851313-6 Banco de la Nación Argentina - Sucursal Villa del Parque (N° 94) Cuenta Corriente: 2400105-72 CBU 01100242-20002400105721 Recuerde agregar en su pago los gastos de transferencia. Envíe comprobante de pago por mail a administracion@teduc.com.ar o por teléfono/fax llamando al (0054-11) 4328-4459/ 4326-1404.

TARJETA DE CRÉDITO (Consulte recargos por pago con tarjeta)

Tipo de Tarjeta: VISA MASTERCARD

N° Cuotas

Datos de la Tarjeta

Nombre(s) Apellido(s)

Número de Tarjeta Código de Seguridad

Vencimiento DNI

Domicilio Teléfono

Datos de Facturación

Nombre/Apellido o Razón Social

Cuit

Dirección Teléfono 1.2

570_NEWCERTAPP_2013_FINAL_7-18-12.DOCX 9

API 570 Test Registration

Applicant’s Name: _________________________________________

Exam ID # (If previously assigned):

Examination Locations and Dates

Please indicate your preferred exam date and location listed below.

December 5, 2012 (Application Deadline – API must receive no later than September 17, 2012)

June 5, 2013 (Application Deadline – API must receive no later than March 20, 2013)

September 25, 2013 (Application Deadline – API must receive no later than July 10, 2013)

Application deadlines are firm — no exceptions will be made.

*NOTE: An additional sitting fee will be required at the Edmonton location in December. You will receive information, prior to the exam date, from ABSA / API, with payment instructions.

North America:

Anchorage, AK * Edmonton, AB (Canada) Oakland, CA

Atlanta, GA Houston, TX Oklahoma City, OK

Baton Rouge, LA Indianapolis, IN Philadelphia, PA

Corpus Christi, TX Los Angeles, CA

Other Locations:

Abu Dhabi, UAE Chennai, India Kuala Lumpur, Malaysia

Safat (Kuwait City), Kuwait

Al-Khobar, Saudi Arabia Chia, Colombia Mumbai, India Singapore, Singapore

Cairo, Egypt Doha, Qatar Port of Spain, Trinidad

United Kingdom (contact API for city info)

If a location of your choice is not listed above please contact API for more information. If you are testing at an API-approved special site, please include the location and/or

group here:_________________________________________ City, Country

> > THIS FORM MAY ALSO BE USED TO RESCHEDULE A TEST << If rescheduling, please remember to include the re-test fee.

570_NEWCERTAPP_2013_FINAL_7-18-12.DOCX 10

FOREIGN LANGUAGE WAIVER for ICP CERTIFICATION EXAMS

OUTSIDE OF UNITED STATES (Complete this form only if testing in a language other than English.)

Please complete and sign the form below to take the API exam in a Foreign Language. This

form is sufficient for all your attempts within a given program until you obtain your

certification. If you do not submit this form, or the form is incomplete, you will take the exam in

English. Please note: Translations are not available for all languages or all programs, and API

does not guarantee that your requested translation will be available. Make sure to visit the API

website and confirm language availability prior to applying.

I, ________________________________________________________ ID # __________________

(Please print your full name above. If you hold another certification with API please include that number)

request to take the following examination in a foreign language:

API program: _______________________________________

Location: ___________________________________________

Language requested: __________________________________

Assumption of the Risk and Waiver of All Claims

Read this carefully before signing. Translation of technical terminology and complex subjects is difficult and subjective. API cannot

warrant that the foreign language translations of API materials are accurate. By signing this form, you

agree to assume any risk of inaccurate translations and also to waive any claim against API related to

the accuracy of the translated exam.

I, the undersigned, agree to the following:

1. I agree to take the API __________ examination in a foreign language. I understand that the

technical translation of the terminology in the course of the examination may or may not be

familiar and acceptable to me.

2. In the event of my failing the examination I agree to hold API harmless against any claims related

to the language of the examination.

3. In the event of my failing or not taking the examination I understand and agree that API will not

make any refunds of my application fees or be liable for any damages whatsoever.

4. API shall be the sole judge or whether I have the appropriate qualifications to become certified

under API Individual Certification programs.

Signature: ____________________________________________

Full name: _____________________________________________

Company Name: ________________________________________

Date: ______________________________________________

570_NEWCERTAPP_2013_FINAL_7-18-12.DOCX 16

API 570 – Information on Exam Publications

Applicant’s Name: _________________________________________

Exam ID # (If previously assigned):

PLEASE ANSWER THE FOLLOWING QUESTIONS AND REVIEW THE IMPORTANT COPYRIGHT NOTICE BELOW.

Do you intend to take an exam preparation training class?

YES NO

If yes: Name of training provider _____________________________

Will the exam publications be provided to you by the training company?

YES NO

If the exam publications will not be provided, how will you obtain the necessary exam materials?

_________________________________________________________________________________

Include proof of legal purchase:

a) Company subscription ID ___________________________________________________

Note: Companies with an API subscription may print the relevant ICP documents for their employees only. Exam attendees are not allowed to bring in subscription documents from companies other than their own. Such documents may be confiscated during the exams.

b) Receipt or invoice number __________________________________________________

c) If other, please include how publications were acquired __________________________

COPYRIGHT NOTICE TO ALL ICP EXAM CANDIDATES: Please be reminded that API and ASME documents and publications are copyrighted materials. Reproducing these documents without API permission is illegal. Due to heightened use of illegal copies, API will be conducting random audits at various exam sites. If API determines that your exam materials are illegal copies, the documents will be confiscated from you prior to the exam.

Please ensure you obtain legal copies from one of API’s authorized redistributors:

IHS Documents: www.global.ihs.com; Phone: 1-800-854-7179

Techstreet: www.techstreet.com; Phone: 1-800-699-9277

* API members are eligible for a 30% discount on all API documents; exam candidates are eligible for a 20% discount on all API documents. When calling to order, please identify yourself as an exam candidate and/or API member. Prices quoted will reflect the applicable discounts. No discounts can be made for ASME documents.

If you have questions regarding the authenticity of your documents, please contact API. If you know of any training company or organization distributing unauthorized copies of ICP exam materials, please contact API immediately with this information.

570_NEWCERTAPP_2013_FINAL_7-18-12.DOCX 17

API 570 Exam Publications Effectivity Sheet

FOR: December 5, 2012 and June 5, 2013 and September 25, 2013

Listed below are the effective editions of the publications required for this exam for the date(s) shown above.

Please be advised that API and ASME documents and publications are copyrighted materials.

Reproducing these documents without API permission is illegal. If exam proctors determine that your

documents are illegal copies, the illegal documents will be confiscated from you prior to the exam.

API Standard 570, Piping Inspection Code: Inspection, Repair, Alteration, and Rerating of In-Service Piping

Systems, 3rd Edition, November 2009.

API Recommended Practice 571, Damage Mechanisms Affecting Fixed Equipment in the Refining Industry,

2nd EDITION, April 2011.

ATTENTION: Only the following sections / mechanisms from RP 571 are included on the exam:

Section 3 – Terms (Definitions)

Mechanisms:

Par. 4.2.7 Brittle Fracture

4.2.9 Thermal Fatigue

4.2.14 Erosion/Erosion Corrosion

4.2.16 Mechanical Fatigue

4.2.17 Vibration-Induced Fatigue

4.3.1 Galvanic Corrosion

4.3.2 Atmospheric Corrosion

4.3.3 Corrosion Under Insulation (CUI)

4.3.5 Boiler Water Condensate Corrosion

4.3.7 Flue Gas Dew Point Corrosion

4.3.8 Microbiologically Induced Corrosion (MIC)

4.3.9 Soil Corrosion

4.4.2 Sulfidation

4.5.1 Chloride Stress Corrosion Cracking (Cl-SCC)

4.5.3 Caustic Stress corrosion Cracking (Caustic Embrittlement)

5.1.3.1 High Temperature Hydrogen Attack (HTTA)

API Recommended Practice 574, Inspection Practices for Piping System Components, 3rd Edition, Nov. 2009.

API Recommended Practice 577, Welding Inspection and Metallurgy, 1st edition, October 2004.

API Recommended Practice 578, Material Verification Program for New and Existing Alloy Piping Systems, 2nd

Edition, March 2010.

American Society of Mechanical Engineers (ASME), Boiler and Pressure Vessel Code, 2010 Edition, w/2011

Addendum, July 2011

i. Section V, Nondestructive Examination, Articles 1, 2, 6, 7, 9, 10, and 23 (Section SE-797 only).

ii. Section IX, Welding and Brazing Qualifications, Welding only

American Society of Mechanical Engineers (ASME)

B16.5, Pipe Flanges and Flanged Fittings, 2009 Edition

B31.3, Process Piping, 2010 Edition

_________________________________________________________________________ Please ensure you obtain authorized documents from one of API’s redistributors:

Techstreet: www.techstreet.com; Phone: 1-800-699-9277

IHS Documents: www.global.ihs.com; Phone: 1-800-854-7179