Application for Associate Member Photo Identity Card

*ST/T No.
To
The Director (Membership)
The Institution of Engineers (India)
8 Gokhale Road
Kolkata 700 020 Paste one recent
colour passport
size photo

Name of the Candidate (in capital letters)

Membership Grade and No.

A M

New Address
(in capital
letters)

Pin State

Country Mobile

E-mail

Specimen Signature
of the applicant
(preferably in English)

N. B. : Duly filled in proforma along with the photograph should be sent to the Director (Membership),
to above mentioned address by SPEED POST only.