Indian Institution of Engineers

(Incorporated by an Act of Govt. of India)

Post Box No.- 10901, Bhikaji Cama Bhavan, R.K. Puram, New Delhi – 110066.
Toll Free: 1800 121 6495 website: www.iieinstitution.com
Application form for Affiliation (Student’s Chapter)
Application No. …………………………. Dated……………………………
(For office use only)

(Use block letters only)

1. Information of Institute / Individual:

a. Name of Institute/Individuals : ....................………………………………………………………

b. Postal Address : ....................………………………………………………………

....................………………………………………………………
....................………………………………………………………

c. Phone/Fax/Email/Telex : ....................………………………………………………………
....................………………………………………………………

d. Year of Establishment : ....................………………………………………………………

2. Information About Director /Proprietor /Partner :

a. Name : ....................………………………………………………………

b. Postal Address : ....................………………………………………………………

....................………………………………………………………
....................………………………………………………………
....................………………………………………………………

c. Phone/Fax/Email/Telex : ....................………………………………………………………
....................………………………………………………………

d. Date of Birth & age : ....................………………………………………………………

e. Education Qualification : ....................………………………………………………………

3. Infra Structural Facilities:

a. Facilities Available:
Particulars Nos. of Rooms Seating Capacity Total area (Sq. Ft.)
Staff Rooms
Class Rooms
Library
Reception
Toilets
Any Other
(Where ever necessary relevant details / documents must be enclosed)

b. Location of the Institute/Individual : ....................………………………………….………….

c. Rented/Lease/Own Building: ....................………………………………………………………

(Attached Relevant Documents)
4. Institute Photographs Interior And Exterior:

Building/Floor Photographs of Reception Photographs

Institute (Elevation) of Institute (Interior)

Class Rooms Photographs of Director Rooms

Institute (Interior) Photographs of Institute
(Interior)

You can attached more photos in separate sheet

5. Information About Supporting Staff:

S. Name Designation Education Total Date of Status

No. Qualification Professional Appointment Full/Part
Experience Time

Information required regarding supporting faculty. (If necessary attach separate sheet)

6. Name Of Person Who Will Actively Manage the IIE (Student’s Chapter):

a. Name : ....................………………………………………………………

b. Phone/Fax/Email/Telex : ....................………………………………………………………
....................………………………………………………………

c. Education Qualification : ....................………………………………………………………

Signature and Seal of the Institute/Individual

DD/Cheque/NEFT/RTGS No. ……………………Dated……..…..…….. (`)…………….…………

in favour of “Indian Institution of Engineers” Payable at New Delhi.