PAC Act 2011
FORM D: REJOINING THE REGISTER
SECTION A: PARTICULARS OF APPLICANT
Application Form for Re-joining the Register
FILL IN ALL FIELDS APPLICABLE TO YOUR SITUATION (To be completed in block letters)
Family Name : …………………………………………………………………………………………………………………………………….
Other Names : …………………………………………………………………………………………………………………………………….
Gender : M F Citizenship : …………………………………………………………………………..
(In addition to the Mauritian nationality)
Country & City of Birth : …………………………………………………………………………………………………………………………
Date of Birth (DD/MM/YYYY): ………… / ………… /……………
Identity Card: ……………………………………………………………. Passport No: ………………………………………
Country & City of issue: …………………………………………………………….. Date (D/M/Y): …………………………………
PAC Registration Number: ………..
CONTACT DETAILS
Residential Address: ………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………
Tel: ……………………………………. Mobile: …………………………… E-mail………………………………………………………..
Regular Business Name & Address: ………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………
Tel: ……………………………………. Fax: …………………………………. E-mail: ………………………………………………………
SECTION B: CHANGE OF NAME
If your name has changed since you were last on the Register, you will need to submit the relevant
document to support the change in your circumstances, for example a marriage certificate, or Change of Name certificate.
(Strike out if not applicable)
New Family Name : …………………………………………………………………………………………………………………………
New Other Names : …………………………………………………………………………………………………………………………
Document(s) Submitted:
Marriage Certificate (Yes/No)Delete as appropriate Change of Name Certificate (Yes/No)Delete as appropriate
SECTION C: MANDATORY DOCUMENTS
Document(s) Submitted:
Certificate of Character (Yes/No)Delete as appropriate Professional Indemnity Insurance (Yes/No)Delete as appropriate
SECTION D: DECLARATION TO BE SIGNED BY APPLICANT
To: The Registrar
Professional Architects’ Council, Mauritius
I, the undersigned, hereby apply for my name and other particulars as a professional architect
to be restored to the register of professional architects, and
-
- I declare that all particulars given by me in respect of the present application are true,
- I declare to have taken good note of Section 20, 21 & 22 of the PAC Act 2011.
- I agree to abide by the PAC Act 2011, including the Code of Practice & Regulations.
Signature: ……………………………………………… Date (DD/MM/YYYY): …………/ ….………/ …………
