FELLOW INSTITUTE OF TOWN PLANNERS, INDIA Application for Fellow Membership of the Institute To The Secretary General Institute of Town Planners, India 4-A, Ring Road, |.P. Estate NEW DELHI 110002 Sir, 1am desirous of being elected as Fellow of the Institute of Town Planners, India. I promise, if elected, I will abide by and observe the provisions of the Articles and Bye-laws being in force from time to time. I will pay the subscription prescribed for the membership and that I will promote the objectives of the Institute as may be in my power. My particulars are given below. A. FullName (Blockletters) Father’s Name Block eters) ‘Sumame AITP No. Date of Birth (attach proof ) Address for Communication State Country (ifother than India) Phone (Off) FAXEducational Qualifications after High School {attach attested photocopies of degrees/ diplomas, etc. as proof, provisional certificates and/ or mark-sheets are not accepted) S.No, ‘of the Certificate/ Degree! | Yearof Pasing ‘Name of the Board/ College! Diploma,etc. University/ Institution, ete, Particulars of Position(s) Held (and/or other professional experience after obtaining recognised qualification in planning) S.No, | Position Held Period ‘Name of the Employer/ organisation (it'self-employed, stteso) (inention dates) | (self-employed, state name of the firm) Area of Specialisation (please tick four most important areas) Urban Planning; Regional Planning; Rural Development; Urban & Ri Planning and Development Management; Urban Renewal/ Conservation’ Heritage; Housing and Shelter, Planning Legislation; ‘Transportation; Urban & Regional Infrastructure; Urban Design; Environmental Planing, History of Development; Real Estate; Valuation; Fiscal Resource Mobilisation: Informal Sector, Remote Sensing and ‘Geographic Information Systems,E. Membership of other Professional Bodies/ Societies/ Institutions No. | Category of Membership Name of the Body/ Society/ Institute, ete. (please quote membership number) Since Gen) (please attach separate sheet, if necessary) ‘Major Planning Projects/ Research Handled as Team Leader/in Independent Capacity G, Publications in the Kield of Planning ist authored, edited books; papers published and presented; attach separate sheet, if necessary)Participation in IPT Activities ist membership in TTPI Committees, participation in Annual Town and Country Planners Congresses indicating yearand place, membership in Regional Chapters’ Committees; attach separate sheet, if necessary) L. Details of Fees Pai Asrequired by the Bye-laws, I enclose herewith a fecs of Rs, ing the transfer fee and annual subscription OR transfer fee and the Fixed Deposit forlife Membership, in Cash/ vide Bank Draft No. dated drawn on (name of the bank) ‘Gliansferfee Rs.100/-, annual subscription Rs 150/-, LifeMembership Rs.1,500/-) J, Declaration/ Proposal/ Support iB Age ‘years, declare that the information giyen in the previous pages is tue and in case any information given by me is found to be false ora case of misrepresen- tation of facts, my membership may be cancelled by the Institute. Signature Date 7 sFITP, Regn. No. certify thatto the best of my personal knowledge, and subject to any conditions required by the Bye-laws, the above mentioned applicant ‘possesses the qualifications and experience necessary for election as Fellow Member of the Institute and 1 propose his/her name for granting the same. Lam not in arrears of fees as of today. Signature DateWe, the undersigned, certify that the above named applicant is personally known to us and we support his ‘application for Fellow of the Institute, We are notin arrears of fees as of today. Signature, Name FITP, Regn. No. ca! Signature, Name. ,FITP, Regn. No. Signature Name Regn. No. K. Declaration by the Employer (for self-employed, plzase make the declaration on a letterhead of your office/ firm) I, the undersigned, do hereby declare that the above named applicant is working in this organisation si and the particulars provided by him/her are correct as per the details available Thaveno objection in his/her being clected as Fellow of the Institute of Town Planners, india, 2 office. Signature Date Name and Designation -aflix official seal here- Phone (Off) FAX FOR OFFICE USE ONLY Age Fees paid Rs. Basie Qualification Receipt No. BArhBE. CivilIM.A. Geog /Eeonomies/ Socio. Other (specify) Planning Qualification Institution, ‘Year of Passing. Planning Experience (years) Attested photocopies attached Date of Birth Basic Qualification. Planning Qualification Remarks Date Signature (Cashier) ‘Checked by Recommendations of the Scrutiny Committee of the psc Secretary PSC Ciroulated on Approved by the Couneil on FITP No,