Professional Documents
Culture Documents
Son/Daughter/Wife of
(c)....................................................................................................................................
(d)....................................................................................................................................
4. Record of engineering experience since graduation in chronological order. (Ref. item 4.1 of
Guidelines)
5. Professional Development Programme(s)/Activities for last five years, starting from current year.
5.1 Recognised Training Programme(s), Conferences, Seminars, Workshops, Technical
Presentations attended /participated.
2.
3.
4.
5.3 Professional contribution in emergency work (e.g. Flood Relief, Earthquake, Fire
Fighting etc.)
Civil Electrical
Mining Aerospace/Aeronautical
Marine Textile
Agricultural Production
Environmental Mechanical
Any other
Nos.
Enclosures : 1. Qualification Certificate(s)
2. Professional Development
Programmes’ Certificate(s)
3. Bank Draft/Credit Card Rs, No.
Authorisation
4. Others
Sponsors : (From personal knowledge of the applicant and in consideration of his/her qualifications as stated
in the form, we recommend him/her as being in every way a fit and proper person to be certified
as Professional Engineer ( Ref. item 5 of Guidelines)
(a) Examination
Yes No
Discipline ...............................…………..
Reference No..........................…………..
Date........................................…………..
________
Signature
___________________________
Authorised Signatory’s designation
_______________________________
Name of professional engineering association
Verification
________
Signature
_________________________
Authorised Signatory’s Designation
for Board for Certification of Professional Engineer
Report on Shri/Smt………………………………………………………
Yes No
4. If yes please give your own impression of the candidate and why you consider him/her a fit
person to be certified as professional engineer, identifying his/her engineering qualities &
achievement (around 50 words)
Signature: ……………………………………………………………..
………………………………………………
E-mail id : ………………………………………………
To
Board for Certification of Professional Engineer
The Institution of Engineers (India)
8 Gokhale Road
Kolkata – 700 020