PHILIPPINE INSTITUTE OF CIVIL ENGINEERS, INC.

KSA - Riyadh Region Chapter, International Charter No. 02

Order of the Filipino Civil Engineers in Riyadh
www.pice-riyadh.com

Membership Application / Update Form (2015)

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Date :

Membership Status :

Renewed / Reinstated

New

Previous PICE-Chapter :

Life Member

PICE-National ID # :

PRC Registration # :

PICE-KSA Riyadh ID # :

Registration Date :

Regular

Associate

Personal Information
Last Name :

First Name :

Middle Name :

DOB (MM/DD/YY) :

Gender :

Civil Status :

Place of Birth :

Religion :

Company Sponsor :

Iqama No. :

Position :

Passport No. :

Sponsor's Address :

Mobile Phone No. :

Office Phone No. :

Email Address :

Philippine Address :

Province in the Philippines :

Place
Issued :

Educational Details
Baccalaureate Degree :

Post Graduate Degree :

College / University :

College / University :

Year Graduated :

Year Graduated :

Fields of Specialization :
(Project Management / QA-QC / Design / Construction - Roads, Bridges, Buildings / Quantity Surveying / etc.)
Dependents
Dependent

Relationship

Address

Applicant's Sworn Statement :

I will follow the rules and regulations of the Institute as prescribed under the Philippine Institute of Civil Engineers, Inc. Kingdom of
Saudi Arabia Riyadh Region Chapter By-Laws, and I fully understand that any incorrect information mentioned above shall be the
cause of my automatic dismissal.

Payment O.R. # :

Confirmed by :

Applicant's Signature :

ENGR. RUSMAR IAN D. TIJING

VP-Finance (2015)

Accepted by :

ENGR. ALVIN L. CEBALLOS

VP-Membership (2015)

Noted by :

ENGR. NOEL ANDY B. SATURNO

VP-Education (2015)

Approved by :

ENGR. TEDDY R. MANZANO

President (2015)

Required attachments :
MEMBERSHIP COMMITTEE 2015

for Regular / Life Members ( photocopy of PRC License and/or Proof of Passing; 2 pcs. 2x2 ID picture)
for Associate Members ( photocopy of College Diploma and/or Transcript of Records; 2 pcs. 2x2 ID picture)