Professional Documents
Culture Documents
Registration of
Professional Engineer (PE) /Associate Professional
Engineer (APE)
APPLICATION FORM
Serial No. ______________
1.
1.1
Personal Particulars
Name (In Capital Letters)
Place of Birth
___________________
Photograph
Nationality
1.3 Male
1.4 Single
Female
Married
1.5: Present Organisation/ Work Place Name and Address with Pin code:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Present Position in Organisation/Work
Place_____________________________________________________________
Tel.
____________________________________
Fax ______________________________________________
E-mail:
____________________________________________________________________________________________
1.6 Residential Address
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Tel.
Mob
Emai: __________________________________________________________________________________________
Organisation Address
Disciplines/Major Subjects
Year of
Completi
on
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
________________________________________ __________
________________________________________ __________
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
Duration
Nature of Participation
Conducting Organisation
Date
Subject
by/Conducted at
Published
6. Professional Experience
Describe your experience in the following format, for each period of your employment /
involvement in retrospective order i.e. starting from present position in descending sequence. If
self-employed, write self-employed under Position, and give details of experience. Please also
underline the experience in a responsible position of significant engineering activity.
From
to
Position
Organisation
Brief Description
7.
8.
___________________________________
__________________________________ ______________________________
9. Registration Fees- Bank transfer/draft/Pay order in the name of Engineering Council of India
(Account details will be given on request)
Amount in Rs.
Bank
dated
I agree to abide by, the professional Code of Ethics established by Engineering Council of
India, and to be held individually accountable for my action.
I agree that decision of the ECI on Registration and Termination shall be binding on me.
I hereby confirm that the contents of the items described in this application documents are
true and correct.
Enclosures:
1.
One passport size photo
2.
Self attested copies of all Educational Qualification Certificates
3.
Self attested copies of all Certificates of membership of Professional Bodies
4.
Registration Fee (Multi city Cheque/Bank Draft/NEFT details).
5.
Names and details of the two referees.
11. I am known to the following two referees (engineers):1) Name
:Address :Contact Details:- Email:Telephone No.:Mobile No.:Knows since (Period):2) Name
:Address :Contact Details:- Email:Telephone No.:Mobile No.:Knows since (Period):-
Date: dd/mm/yyyy:
________________________