AAF9 - Membership Application Form: ESOS v2.0

1.0 Introduction
The information you provide will be used to register you with Stroma Certification’s Energy Savings Opportunity Scheme (ESOS) on completion of the assessment and training course.

Please only apply for certification if you are able to demonstrate a minimum length of two years of professional energy assessment and energy audit experience relevant to the PAS 51215. If you wish to discuss this further please contact Stroma Certification before proceeding.

Before completing this application form, you must read the ESOS Members Pack. (Download Members Pack).
2.0 Personal Details (the 'Named Applicant')
Name Name * Title First Last Suffix
Date of Birth Date of Birth * / DD / MM YYYY
Work Telephone Number
Mobile Telephone Number *
Email Address *
Company Name *
Company Address Company Address
Street Address Address Line 2 City County Postcode Country
Do you require your invoice to be sent to an alternative address? *

Do you require your invoice to be sent to an alternative address? Yes - please provide details below. No - please continue with your application.
Invoice Address:
If different from Company
Invoice Address:
If different from Company

Street Address Address Line 2 City County Postcode Country
3.0 Existing Certification
Are you an existing Stroma Certification Scheme Member? *

Are you an existing Stroma Certification Scheme Member? Yes No
Membership Number
If No, do you hold certification with another Scheme or Professional Body?

If No, do you hold certification with another Scheme or Professional Body? Yes No
Scheme/ Professional Body Name

If Yes, please provide details below by ticking the relevant box(es) or select "N/A":

Strand
	Apel	Qual	N/A
Non-Domestic Energy Assessor (NDEA)	Non-Domestic Energy Assessor (NDEA)Apel	Non-Domestic Energy Assessor (NDEA)Qual	Non-Domestic Energy Assessor (NDEA)N/A
Operational Ratings Energy Assessor (OREA)	Operational Ratings Energy Assessor (OREA)Apel	Operational Ratings Energy Assessor (OREA)Qual	Operational Ratings Energy Assessor (OREA)N/A
Green Deal Advisor (GDA)	Green Deal Advisor (GDA)Apel	Green Deal Advisor (GDA)Qual	Green Deal Advisor (GDA)N/A
Air Conditioning Energy Assessor (ACEA)	Air Conditioning Energy Assessor (ACEA)Apel	Air Conditioning Energy Assessor (ACEA)Qual	Air Conditioning Energy Assessor (ACEA)N/A
Domestic Energy Assessor (DEA)	Domestic Energy Assessor (DEA)Apel	Domestic Energy Assessor (DEA)Qual	Domestic Energy Assessor (DEA)N/A
On-Construction Energy Assessor (OCDEA)	On-Construction Energy Assessor (OCDEA)Apel	On-Construction Energy Assessor (OCDEA)Qual	On-Construction Energy Assessor (OCDEA)N/A
Other	OtherApel	OtherQual	OtherN/A

4.0 ESOS Certification
Please confirm below by ticking the relevant box(es), the operating area, coverage and sectors in ESOS you will specialise in and hold the appropriate competence for, that meets the requirements of PAS 51215.

Specialism(s) *
Specialism(s)	PAS 51215 Competent	NOT PAS 51215 Competent*
Buildings	BuildingsPAS 51215 Competent	BuildingsNOT PAS 51215 Competent*
Process Energy	Process EnergyPAS 51215 Competent	Process EnergyNOT PAS 51215 Competent*
Transport	TransportPAS 51215 Competent	TransportNOT PAS 51215 Competent*

Operating Area - INTERNAL (ESOS only conducted for your employer) *
	Yes	No
Internal - Buildings	Internal - BuildingsYes	Internal - BuildingsNo
Internal - Process Energy	Internal - Process EnergyYes	Internal - Process EnergyNo
Internal - Transport	Internal - TransportYes	Internal - TransportNo

Operating Area - EXTERNAL (ESOS conducted for any company) *
	Yes	No
External - Buildings	External - BuildingsYes	External - BuildingsNo
External - Process Energy	External - Process EnergyYes	External - Process EnergyNo
External - Transport	External - TransportYes	External - TransportNo

Coverage Area* *

Coverage Area* England Wales Scotland Northern Ireland
Registered Country* *

Registered Country* England Wales Scotland Northern Ireland
* Please can you confirm the area of the UK that your company is registered under, and the coverage area for where you are prepared to operate as an LEA. This information is required by the Environmental Agency.
4.1 Competence
On acceptance of your application, you will be required to provide evidence to Stroma Certification on how your competence meets the requirement of PAS 51215 and that you have a minimum 2 years’ experience in energy assessment and energy auditing.
4.2 References
During the assessment process, you will be required to provide 2 references. Stroma Certification will contact them to for their feedback in supporting your application.
Please tick to confirm if you can provide references upon request

Please tick to confirm if you can provide references upon request Yes No
4.3 Personal Statement
Please write a personal statement in the box provided below explaining how your qualifications, experience and on-going learning or any additional experience you have enables you to meet the competence requirements for the ESOS certification scheme you are applying for.
Statement *
5.0 Prior ESOS Applications
Please answer the following questions:
Have you had an ESOS application or membership rejected or revoked by another certification scheme? *

Have you had an ESOS application or membership rejected or revoked by another certification scheme? Yes No
If Yes, please provide as much detail as possible as to why you were rejected and/or revoked from the other certification body.
6.0 Professional Conduct Declaration
Stroma Certification requires that all applicants sign to agree to the Professional Conduct held in the ESOS Scheme Membership Handbook. A copy of the Professional Conduct Declaration form is available in the ESOS Members Pack. Please note that without this being submitted, your application cannot be progressed.
Upload a File

Attach Files
Please tick to confirm

Please tick to confirm I confirm this will be posted to Stroma Certification.
7.0 Payment Options
Stroma Certification will arrange for an invoice to be raised on completion of the pre-assessment and confirmation of your wish to be assessed being received. This invoice must be paid in full before the full assessment can be completed and additional fees may be required if further training or a site-based observed assessment is required.
8.0 Cancellation
The full fee is payable once your application has been accepted. You will receive a confirmation email indicating that an invoice has been issued. You then have up to 3 working days to cancel. After three working days, full payment is required by return of the invoice.
9.0 Supporting Information
All applicants will be required to provide evidence of competence to meet the requirements of PAS 51215 on acceptance of your application. This information will consist of qualifications; training or technical skills held and will need to be produced at the assessment session.
9.1 Insurance
Please provide a copy of your company insurance policy.

For applicants that only undertake ESOS activities internally within their Organisations, insurance is not mandatory to be provided; however should this change to also include external ESOS activity, you will be required to provide a valid insurance policy.
Insurance Policy
Only were external activities are undertaken. (Professional Indemnity insurance (PI) with a recommended minimum limit of £1m).

Attach Files
9.2 Competence
Please provide a copy of CV, and other qualifications, training etc to demonstrate your competence and work experience.
Supporting Files *

Attach Files
10.0 Permission to Contact
We like to keep in touch with our clients by post, phone, email and other electronic means with relevant industry news, exclusive offers, events details, CPDs and the latest information from Stroma Certification and Stroma Group companies. Please be assured we’ll treat your information with the utmost care and will not share your information with other companies for marketing purposes without your express permission. For more information about how we’ll use your data please refer to our Privacy Policy .

Please confirm if you would like us to contact you or not by selecting one of the options below:
I do want to hear about industry news, offers, CPDs/events and Stroma information I do not want to hear about industry news, offers, CPDs/events and Stroma information
You can update your permissions status at any time for receiving communications from Stroma Certification and the Stroma Group by completing the Permissions to Contact form available at www.stroma.com/data-protection.
11.0 Declaration
I declare that the all information provided within this document is true to the best of my knowledge. I confirm that I have read and understood all policies, terms and documentation provided within the ESOS Members Pack. I promise to abide by all rules and ensure that all terms, conditions and standards currently defined within these polices, terms and documentation will be fully adhered to. I also accept that this Application and License Agreement (and all other policies, terms and documentations within the ESOS Members Pack) may be altered in the future by Stroma Certification (Stroma Certification will notify the applicant of any changes made) and agree to abide by all subsequent changes made. The information on this form supersedes all previous versions.

Furthermore, I confirm that by ticking the below box, I hereby agree that my company details will be published on the Stroma Certification website as part of my on-going certification and shared with other ESOS Participants/Stakeholders where required by the scheme.

Stroma Certification will ensure compliance with the General Data Protection Regulation (GDPR) when processing the personal information that you have included within this document. Stroma Certification will only use this information in accordance with the training provider and/ or certification scheme requirements and to contact you about other opportunities with Stroma if you have given permission for this to happen. If you would like to find out more information about Stroma Certification’s compliance with GDPR and your personal data, please visit our website (Data Protection). If you have any questions concerning data protection or the use of your personal data, please contact us before submitting this document.
Please tick to confirm *

Please tick to confirm I confirm I agree to all of the above terms & conditions and I am aware of the scheme specific policy documents.
Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Stroma Certification Ltd

Issued Date: 16/06/2021
Issue Revision: v2.0

AAF9 - Membership Application Form: ESOS v2.0

AAF9 - Membership Application Form: ESOS v2.0

2.0 Personal Details (the 'Named Applicant')

3.0 Existing Certification

4.0 ESOS Certification
Please confirm below by ticking the relevant box(es), the operating area, coverage and sectors in ESOS you will specialise in and hold the appropriate competence for, that meets the requirements of PAS 51215.

4.1 Competence
On acceptance of your application, you will be required to provide evidence to Stroma Certification on how your competence meets the requirement of PAS 51215 and that you have a minimum 2 years’ experience in energy assessment and energy auditing.

4.2 References
During the assessment process, you will be required to provide 2 references. Stroma Certification will contact them to for their feedback in supporting your application.

4.3 Personal Statement
Please write a personal statement in the box provided below explaining how your qualifications, experience and on-going learning or any additional experience you have enables you to meet the competence requirements for the ESOS certification scheme you are applying for.

5.0 Prior ESOS Applications
Please answer the following questions:

8.0 Cancellation
The full fee is payable once your application has been accepted. You will receive a confirmation email indicating that an invoice has been issued. You then have up to 3 working days to cancel. After three working days, full payment is required by return of the invoice.

9.2 Competence
Please provide a copy of CV, and other qualifications, training etc to demonstrate your competence and work experience.

You can update your permissions status at any time for receiving communications from Stroma Certification and the Stroma Group by completing the Permissions to Contact form available at www.stroma.com/data-protection.

Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Stroma Certification Ltd

Issued Date: 16/06/2021
Issue Revision: v2.0

AAF9 - Membership Application Form: ESOS v2.0

AAF9 - Membership Application Form: ESOS v2.0

2.0 Personal Details (the 'Named Applicant')

3.0 Existing Certification

4.0 ESOS Certification Please confirm below by ticking the relevant box(es), the operating area, coverage and sectors in ESOS you will specialise in and hold the appropriate competence for, that meets the requirements of PAS 51215.

4.1 Competence On acceptance of your application, you will be required to provide evidence to Stroma Certification on how your competence meets the requirement of PAS 51215 and that you have a minimum 2 years’ experience in energy assessment and energy auditing.

4.2 References During the assessment process, you will be required to provide 2 references. Stroma Certification will contact them to for their feedback in supporting your application.

4.3 Personal Statement Please write a personal statement in the box provided below explaining how your qualifications, experience and on-going learning or any additional experience you have enables you to meet the competence requirements for the ESOS certification scheme you are applying for.

5.0 Prior ESOS Applications Please answer the following questions:

8.0 Cancellation The full fee is payable once your application has been accepted. You will receive a confirmation email indicating that an invoice has been issued. You then have up to 3 working days to cancel. After three working days, full payment is required by return of the invoice.

9.2 Competence Please provide a copy of CV, and other qualifications, training etc to demonstrate your competence and work experience.

You can update your permissions status at any time for receiving communications from Stroma Certification and the Stroma Group by completing the Permissions to Contact form available at www.stroma.com/data-protection.

Produced By: Steven Marriott Authorised By: Sam Cantle On behalf of Stroma Certification Ltd Issued Date: 16/06/2021 Issue Revision: v2.0

4.0 ESOS Certification
Please confirm below by ticking the relevant box(es), the operating area, coverage and sectors in ESOS you will specialise in and hold the appropriate competence for, that meets the requirements of PAS 51215.

4.1 Competence
On acceptance of your application, you will be required to provide evidence to Stroma Certification on how your competence meets the requirement of PAS 51215 and that you have a minimum 2 years’ experience in energy assessment and energy auditing.

4.2 References
During the assessment process, you will be required to provide 2 references. Stroma Certification will contact them to for their feedback in supporting your application.

4.3 Personal Statement
Please write a personal statement in the box provided below explaining how your qualifications, experience and on-going learning or any additional experience you have enables you to meet the competence requirements for the ESOS certification scheme you are applying for.

5.0 Prior ESOS Applications
Please answer the following questions:

8.0 Cancellation
The full fee is payable once your application has been accepted. You will receive a confirmation email indicating that an invoice has been issued. You then have up to 3 working days to cancel. After three working days, full payment is required by return of the invoice.

9.2 Competence
Please provide a copy of CV, and other qualifications, training etc to demonstrate your competence and work experience.

Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Stroma Certification Ltd

Issued Date: 16/06/2021
Issue Revision: v2.0