APPLICATION FORMAT FOR CHARTERED ENGINEER CERTIFICATE

The Director (Membership) For Office Use Only

The Institution of Engineers (India)
8 Gokhale Road
Kolkata 700 020

Dear Sir,
You are requested to consider my application for issuing Chartered Engineered Certificate. I give below the
following factual information as marked (
) in the appropriate box.
1. I have not applied for Chartered Engineer Certificate earlier. Therefore, an amount ` 8850/US $ 750 is
being paid by Demand Draft (DD)/cash/online. Details are given below
2. I had applied for Chartered Engineer Certificate earlier and received the same. Please find enclosed
photo copy of the certificate. Therefore, an amount of ` 2360/US $ 200 is being paid by Demand Draft
(DD)/cash/online. Details are given below.

I hereby confirm that I am entitled for Chartered Engineer Certificate as I have compounded by annual subscription for
life/made full payment of the Composite Subscription as Clause 69(vi) of the Bye-Laws of The Institution of Engineers
(India)

My Membership Grade and Number is AM/M/F

Full Name (Block Letters) : ............................................................................................................................................

*Address (Block Letters) : .............................................................................................................................................

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

. ......................................................................................... Pi n :

Phone/Mobile No. .............................. E-mail : ........................................................................

________________________________________
Full Signature with Date
Enclosures : As tick marked (
) below.
I am enclosing following documents for your kind consideration [tick (
) appropriate box]
As per Serial No : 1 above
Demand draft of ` 8850 (US $ 750 for members residing in abroad) (Draft No. ...................................) in favour
of The Institution of Engineers (India), payable at Kolkata.
Paid ` 8850 online vide reference no. .................................................... and payment geteway ID/ Transaction
ID.......................................................
As per Serial No : 2 above
Demand draft of ` 2360 (US $ 200 for members residing/working in abroad) (Draft no. .................................) in
favour of The Institution of Engineers (India) payable at Kolkata.
Paid ` 2360 online vide reference no. .................................................... and payment geteway ID/ Transaction
ID.......................................................
Photocopy of Chartered Engineer Certificate issued to me earlier.
*The Certificate will be sent to the address as recorded in our database. For any change in the address, please
login to our website to update your address or apply for the same.

Form No. MEMB/10

Rev. 07/30062016