Registration Form
for the
Functional Safety Engineer (FSengineer)
Functional Safety Professional (FSP)
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1 Applicant Registration Information
Applicant Birthday
PHOTOS Position Title Sex
Highest education Experiences Years of FS Telephone Telefax
MSN: E-mail
Company & Department Name / Company Address Website Reference 1 (Indi-vidual) Position Title/ Company E-mail of Refer-ence 1
Phone No. of Ref-erence 1 Reference 2
(Indi-vidual) Position Title/ Company
E-mail of
Refer-ence 2 Phone No. of Ref-erence 2
I, the undersigned, hereby confirm the validity of above information.
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2 Eligibility Requirements
Eligibility Requirements
Functional Safety Engineer (FSengineer) /FS engineer
With 2 years experience in the applicable industry at least
With Engineering Education diploma
With Two references from employed company
Have certain ability on speaking English and written English (recommended)
Follow a training course and successfully pass the associated exam
Functional Safety Professional (FSP)
6 years experience in the applicable industry
Education gives credits：
Bachelor degree deduct 2 years Masters degree deduct 3 years Ph.D. degree deduct 4 years
Two references from employed company
Have certain ability on speaking English and written English (recommended
Follow a training course and successfully pass the associated exam
Functional Safety Expert (FSE)
10 years experience in the applicable industry
Education gives credits
Bachelor degree deduct 2 years Masters degree deduct 3 years Ph.D. degree deduct 4 years
Submits two case studies
Competence in communication about Functional Safety. This can be demonstration by publications, dissertations,
trainings (as coach), member in FS committees or others
Have certain ability on speaking English and written English (recommended)
To be a Functional Safety Professional
Participant(s)’s declaration based on above I am holding a Bachelor
I am holding a Master degree
I am holding a Ph.D. degree
I have two references in related working experience
I have two case studies in related working experience to submit I have been as an FSEngineer of TÜV SÜD till now
I have been as an FSProfessional of TÜV SÜD till now I have been ___ years’ experience in the applicable industry till
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3 Detailed Informations of applicants
3.1 Functional Safety Relevant Experience
（The form can be added if needed）
Form 01
Experience 1：
Position/Title: Company Name: Location:
Start Date Description of duties
Supervisor / Manager Name
End Date Supervisor / Manager Tel:
Total working months: Supervisor / Manager Mail address:
Experience 2：
Position/Title: Company Name: Location:
Start Date: Description of duties:
Supervisor / Manager Name:
End Date: Supervisor / Manager Tel:
Total working months: Supervisor / Manager Mail address:
Applicant Name: Total number of years of relevant Functional Safety experience:
Signature/Date: Note：
I certify that the above information is correct and accurate to the best of my knowledge. I understand that inaccurate information could void my TÜV certification any time in the future.
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（The form can be added if needed）
Form 02
Experience 3:
Position/Title: Company Name: Location:
Start Date: Description of duties:
Supervisor / Manager Name:
End Date: Supervisor / Manager Tel:
Total working months: Supervisor / Manager Mail address:
Experience 4:
Position/Title: Company Name: Location:
Start Date: Description of duties:
Supervisor / Manager Name:
End Date： Supervisor / Manager Tel:
Total working months: Supervisor / Manager Mail address:
Applicant Name: Total number of years of relevant Functional Safety experience: Signature/Date: Note：
I certify that the above information is correct and accurate to the best of my knowledge. I understand that inaccurate information could void my TÜV certification any time in the future.
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3.2 University Degree (minimum Bachelor's) in relevant field
University or College Technical field (major) Degree earned Date Certificate of Diploma
Name City Country Copy attached (check box) Applicant Name:
Compliance to TÜV SÜD eligibility requirements
Signature/Date: Note：
I certify that the above information is correct and accurate to the best of my knowledge. I understand that inaccurate information could void my TÜV certification any time in the future.
3.3 Competence in communication for TÜV SÜD FSE Certificate
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3.4 Information for TÜV SÜD FSengineer/ FSP / FSE Certificate
(please type or write in capital letters)
Full Name (first name, second name):
(As you would like it to appear on the TÜV Certificate)
Company:
Mailing Address:
E-mail address:
Phone:
Fax:
Comments:
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4 Attachments
Individual ID
CV in English
Diploma copies
Degree certificate copies
Recommend letter
Declaration by TÜV SÜD: The above personal information will never to be offered to any other body or person exclude the
TÜV SÜD FSCP Governance Board .
5 Our service contact
In Germany： Mr Günter Greil Tel/电话.: +49/ (0) 89 - 5791 - 1797 Fax/传真: +49/ (0) 89 - 5791 - 2933 mailto/邮件:[email protected] http://www.tuev-sued.de/ Mr Wolfgang Henke Telefon/Phone电话: +49 (0) 89 5791-3402 Mobil/Cell手机: +49 (0) 160 7044498 mailto邮件:[email protected] http://www.tuev-sued.de/rail In China： Mr. Zhao Yong /赵勇先生 Phone/电话: +86/ (0) 10- 6590- 6186 ext301, Mobile/手机: +86 13910797350 Fax/传真: +86/ (0) 10- 6590- 6182 mailto/邮件: [email protected] http://www.tuv-sud.cn Ms. Li Qian /李倩女士 Phone/电话: +86/ (0) 10- 6590- 6186 ext326, Fax/传真: +86/ (0) 10- 6590- 6182 mailto/邮件: [email protected] http://www.tuv-sud.cn http://www.tuv-sud.cn