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This form shall be filled up by participants who wish to renew their certification.

Applicant's Information

Certificate Information

Details of Applicant's Work Experience Since The Last Certification Date

Period Job Title Company Details of Work Experience / Skills Practised Select File

Courses Attended By Applicant Since The Last Certification Date

Course Date Title of the Course Attended Location No. of CEUs / PDHs Select File

Applicant's Verification

I hereby affirm that the above information provided related to my application for recertification is true and correct, and that Haward Technology may conduct a verification of the recertification activities mentioned above.

Name of Recertification Applicant

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