T to ST

An ISO 9001:2008 Certified Organisation

8 Gokhale Road, Kolkata 700 020

Application for Upgradation from Technician to Senior Technician Membership

(Application to be filled in Block Letters)
for Office Use

ICNC No :

Date of Election :

1. Name of the Applicant : ............................................................................................................

(As per Diploma Certificate)

2. Existing Technician Membership No. : T- ........................................

3. Address for Communication : ............................................................................................................

(To be entered in IEI database)
............................................................................................................

............................................................................................................

4. Mobile/Phone No. : (M) .............................................Tel. ..................................................

5. Email : ............................................................................................................

6. (a) Details of Diploma : ............................................................................................................

(Copy of Final Pass Certificate or
Provisional pass Certificate with all ............................................................................................................
semester mark sheet must be
attached duly certified by IEI ............................................................................................................
Corporate Member FIE/MIE/AMIE
only)

b) Name of the College : ............................................................................................................

c) Name of the University/Board : ............................................................................................................

d) Approval No. of AICTE/MHRD : ............................................................................................................

e) Year of Pass : ............................................................................................................

7. a) Old Identity Card Attached : Yes No

b) If no, State the Reason : ............................................................................................................

Copies of Certificates and other documents attested by Corporate Member (FIE/MIE/AMIE only) are enclosed

I accept responsibility for the accuracy of the particulars contained in the application form with regard to my qualification and agree
that if I am elected the validity of my election shall depend upon the accuracy of such particulars.

Date : Full Signature of the Applicant

NB : If the applicant secured exemption of subjects in Section A/B with Technician membership No., separate application should be
sent to Director (EEA) to transfer the marks/grade of such exemption quoting the new Senior Technician (ST) No. after the
upgradation.

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 T to ST
An ISO 9001:2008 Certified Organisation
8 Gokhale Road, Kolkata 700 020

Proforma for Photo Identity Card

Name : ____________________ __________________________

(in Capitals) [Surname] [Remaining Name]

Specimen Signature of Passport or stamp size

the applicant photograph to be
(Preferably in English) pasted here

(do not sign on the

photograph)
The signature should not touch the box
(Use black ink only)

Supporter : Verified the photograph and signature of the applicant

Name (in Capitals) Membership No. Signature (preferably in English) with date

1. ................................................................................ F/M/AM............................... ...................................................................................

Note : The photograph and signature are to be verified by the existing Corporate Member (FIE/MIE/AMIE only)

Name : ____________________ __________________________

(in Capitals) [Surname] [Remaining Name]

Specimen Signature of Passport or stamp size

the applicant photograph to be
(Preferably in English) pasted here

(do not sign on the

photograph)
The signature should not touch the box
(Use black ink only)

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