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Supporting Document B Referee Declaration Form

The document is a Referee Declaration Form for an engineering assessment by Engineering New Zealand. The nominated referee, Samson Mudapakati, confirms that he has reviewed the applicant Blessy Joy's portfolio and believes it accurately reflects her engineering experience. The form also includes instructions for contacting Engineering New Zealand if needed and emphasizes the retention of the report for assessment purposes.

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Blessy Joy
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27 views2 pages

Supporting Document B Referee Declaration Form

The document is a Referee Declaration Form for an engineering assessment by Engineering New Zealand. The nominated referee, Samson Mudapakati, confirms that he has reviewed the applicant Blessy Joy's portfolio and believes it accurately reflects her engineering experience. The form also includes instructions for contacting Engineering New Zealand if needed and emphasizes the retention of the report for assessment purposes.

Uploaded by

Blessy Joy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Referee Declaration Form

You have been nominated by an engineer, to complete the below referee declaration form in relation to an
assessment they are undertaking with Engineering New Zealand.

The applicant is required to send you a copy of their assessment application portfolio summary together
with this declaration, for you to review and validate. The declaration requires you to confirm, to the best of
your knowledge, that the content of the application is an accurate and authentic reflection of the
applicant’s engineering experience, knowledge and competence.

If the applicant is applying for Chartership, you will also receive a separate email from Engineering New
Zealand, with a link to the online portal, where you will be asked to provide more detailed feedback on the
applicant’s technical and professional competence and suitability for registration.

If you wish to contact Engineering New Zealand directly regarding this application, please contact us at
[email protected].

REFEREE DECLARATION PAGE 1 OF 1


Applicant details
Full Name BLESSY JOY

Engineering New Zealand 2023920


customer number/CPEng
number

Referee details
Full Name Samson Mudapakati

Job title Academic Lead – Electrical and Mechanical

Company name Manukau Institute of Technology

Email [email protected]

Mobile Number 0211356037

Relationship to applicant Lecturer

Professional Registration
Number (if available)

Referee declaration
✘ I confirm that I have reviewed the applicant’s portfolio of evidence, and to the best of my
knowledge, the content of the application and work referenced as evidence are a true reflection of
the applicant’s engineering work experience, knowledge, and competence.

✘ I understand that Engineering New Zealand may contact me directly if they have any questions
regarding the applicant’s evidence or my verification of it.

✘ By submitting this report, I understand and acknowledge that my report will be used and retained by
Engineering New Zealand for assessment purposes.

Referee signature

Date
10/04/2025

Please return the completed declaration to the applicant.

REFEREE DECLARATION PAGE 2 OF 1

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