JR

Application for Interim Registration

Your contact details

Forename(s): George Surname: Mathews

Title: Dr / Miss / Mr / Mrs / Mr Date of Birth: 16th August 1986

Ms / Prof / Other
EI membership 0072588 EI membership Associate Member 5+ years
number grade

Home address Work address if applicable

House, building House no F93, First floor, Suncity, McDermott, 4th Floor, Infinity Tower-B,
name and street Sector 54, DLF Cyber City, Phase II, Sector 25-A,

Town Gurugram, Haryana, Gurugram, Haryana,

County India India

Postcode: 122011 122002

Telephone: Not available Not available

Mobile: 00919560580044 00919560580044

Email: george2mathews@gmail.com george.mathews@mcdermott.com

Please send correspondence to the address indicated Home Work

If left blank, we will use your home address 
.

I wish to apply for

Interim Registration with the Engineering Council in relation to the following professional
title (please tick to indicate)

Engineering Technician
Incorporated Engineer
Chartered Engineer 

Professional Membership Application Form. © Energy Institute. June 2017

1
JR

Your qualifications
We will need to see evidence for each of the qualifications you include in this section. Please
supply copies of your certificates or a letter of confirmation. These need to be signed as true and
accurate copies by someone who has seen the originals, for example a line manager or
professional member of the EI.

Academic and vocational

Start End Course title University / College Grade Full time Evidence
date date obtained / Part enclosed
of of time √
study study
Jun July Master of Technology University of 93.2% Full 
2011 2013 (M.Tech) in Pipeline Petroleum and Time
Engineering Energy Studies,
Dehradun, India

April May Bachelor of Technology Mahatma Gandhi 79% Full 

2005 2009 (B.Tech) in Mechanical University, Kerala, Time
Engineering India

Professional qualifications, memberships and registrations

Professional Title Awarding Body Grade or title Year of Award Evidence

enclosed
√
- - - - -

Professional Membership Application Form. © Energy Institute. June 2017

2
JR

Your employment history

Please list your employment history in chronological order, starting with your current employer if
applicable.

Your current employer

Start date of Employer Job title

Employment
18th Feb McDermott (Gurgaon, India / Dubai, UAE) Pipeline and Piping Design
2019 Engineer

Previous employment

Start date of End date of Employer Job title

Employment Employment
12th May 5th Feb L&T Gulf Private Limited Pipeline and Piping
2013 2019 (Larsen and Toubro (India) ) Design Engineer
10th July 4th May Petron Engineering construction Limited Piping / Mechanical
2009 2011 (KazStroyService Group Company) Engineer

Professional Membership Application Form. © Energy Institute. June 2017

3
JR

Your declaration and signature

I have read and agree to the Terms and Conditions in respect of the level of membership and or
professionals registrations for which I am applying. I have read and agree to abide by the Energy
Institute’s Code of Conduct and by any Codes or requirements pertaining to any professional
registrations granted to me by or through the EI as they now are or may thereafter be altered. I
understand, in making this application, that I am giving my consent for the EI to hold my
personal data on its computer database, and that this data will be managed in accordance with
the EI’s Privacy Policy. The statements I have made in my application and in the supporting
evidence I have provided are true and accurate record of my education, experience and
qualifications to date.

Signature:

Date:
14th April 2019

Please submit your completed electronic application form and supporting documents to:
e: professionals@energyinst.org
Professional Membership Manager
Energy Institute
61 New Cavendish Street,
London
W1G 7AR
United Kingdom

Professional Membership Application Form. © Energy Institute. June 2017

4