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Chapter----------------------------------- Referred by------------------------------
To, The Hon.Gen.Secretary, MEMBERSHIP APPLICATION FORM
Photograph of applicant Confederation of Engineers (India), Please enroll me as Fellow / Member/ Student/ Member under the category of (Please Tick) Architectural Engineering Aeronautical Engineering Agricultural Engineering Chemical Engineering Civil Engineering Electrical Engineering Electronics Engineering Industrial Engineering Production Engineering Mechanical Engineering Metallurgical Engineering Mining Engineering Marine Engineering Structural Engineering Nuclear Engineering Textile Engineering Tools Engineering Public Health Engineering Foundry Engineering Name of the Applicant ( Mr./ Mrs./.Ms./Dr./Others ) Name of Establishment Firm
Designation : Proprietor Partner Associate Director
Date of Birth Age Years Gender - Male / Female
Permanent Address Present Address
Telephone Telephone Mobile No. : E mail: ( Please Tick mark appropriate for correspondence address.)
Educational Qualification: ( Give Details of School, College Name and University )
Experience : ( if any ) Please attach separate sheet
If you belong to any other association / society / institution please list them here
Please enter the attached documents below Encl:
Structure of Fees : LifeTime Membership Fees For Certified Engineer Title ( C.Eng.) : Rs. 10,000 /- LifeTime Membership Fees For Chartered Engineer Title ( C.Eng.) : Rs. 15,000 /-
UNDERTAKING : In the event of my selection to any grade to membership of the Confederation of Engineers ( India ), I promise to abide by the constitution, code of ethics and Bye-laws of the Confederation of Engineers ( India ). I declare that the particulars given above are true & correct to the best of my knowledge.
Signature of Applicant ( in full )
FOR OFFICE USE ONLY :
Application verified by : Hon.Gen.Secretary and found correct. Application approved at the Executive Committee Meeting held on Membership No. Allotted
Received Cash/ Cheque / Demand Draft of Rs. /- No. Bank
Instructions For Filling Up The Form :
Fill up entire form in Capital Letters Only,
Attach Certified/ Attested copies of other institutional memberships also,
Affix latest passport size photograph on the application, another two photographs,
Please inform change of address for correspondence, if changed any time during the Membership to avoid inconvenience to each other,
Fees once paid not Transferable or Refundable,
Demand Draft should be in favour of Confederation of Engineers ( India ), Payable at Pune.