(a Govt.

of THE INSTITUTION OF CIVIL ENGINEERS (INDIA)

(A Govt. of India Recognized Degree Level Institution) PLEASE PASTE
309-310, Suncity Trade Tower, Sector 21, Gurugram, Haryana-122016 PASSPORT SIZE
Ph. No. : 0124-4128301-02-03 ATTESTED
Email: info@ice.net.in / iceinstitutions@gmail.com PHOTOGRAPH
Website : www.ice.net.in HERE
Regd. Off : ‘Career House’ Bindra Complex, Model Town, Ludhiana (Punjab)

[Application Form for Corporate Membership (MICE(I)]

1. Name in full (Block letters): :

___________________________________________________
2. Father's/Husband's Name :
___________________________________________________
3. Designation :
___________________________________________________
4. Address :
___________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

City : ______________________________________________

State: _____________________________________________
Pin Code :
Landline No. : ______________________________________
Mobile No. : ______________________________________
E-mail ID : ______________________________________
5. Date of Birth : Age as on date of Application
:________________________
D M Y
6. Highest Qualification :
___________________________________________________

7. Total Experience in the appropriate filed : Years (Experience after Graduation________________Years)

8. Educational Qualifications (Engineering only) :

Sl. Examination Discipline Name of Percentage Name of Year of Authenticated by Hon.

No. Passed the Marks University/Institution Passing Fellow/Fellow/Head,
College Inst. Member/Member

1. B.E./B.Tech/
B.Arch.

2. M.E./M.Tech/
M.Arch.

3. Ph.D.

Signature
4. Any Other Membership No.
9. Details of Experience:
Sl. Post Held Name & Address of the Employer From To Authenticated by Hon. Fellow
No. (Date) (Date) /Fellow/Head, Inst. Member/
Member

Signature
Membership No.

10. Details of Membership in other Institutions / Professional Societies:

Sl. Grade of Membership & Number Name of Institution / Society
No.

11. Details of Fee Paid:

Rs.________________(Rupees____________________________________) Fee Structure

Membership Annual Life
DD No._____________________________Date*_____________________ Fee Subscription Membership
Name of the Bank_______________________________________________ Fee Fee
*drawn in favour in the Institution of Civil Engineers (India) payable at Rs.500/- + Rs.500/- or Rs.5000/-
Ludhiana.
(Payable alongwith the Application Form)

Date :
Place :
Signature
Note :
1. DD to be drawn in favour of ICE (I) payable at Ludhiana.
2. Please write your Name, Membership No. if any, address on the back of the DD.
UNDERTAKING
1. I hereby apply for admission as a Member of the Institution of Civil Engineers (India) in accordance with the
Rules & Regulations and the Bye-laws as they stand now or may be amended from time to time.
2. The particulars contained in the application form are true as I understand that the validity of my admission
depends upon the accuracy of these particulars.
3. I undertake to abide by professional conduct rules and/or code of conduct that the institution may frame
from time to time.
4. The decisions of the institution in granting me the Membership shall be final and binding on me.
5. I shall regularly nenew my membership by paying annual subscription fee.
6. I shall promote the objects of the Institution as far as may be in my power.
7. In the event of invalidity of my Membership for any reason l shall forthwith cease to describe myself as a
Member of the ICE(I).
8. If I withdraw my Membership from the Institution I shall do so after payment of any arrears that may be
due from me to be free from this obligation.
Signature
Attested
Corporate Members, ICE(I)
Signature & Membership No.
Endorsement by the Sponsors

1. Name Membership Number, ICE(I)

FOR OFFICE USE OF ICE(I)

Received with thanks duly filled in Application Form for Fellow/Member from…………………………………..alongwith
DD No……………………………………….…for Rs……………………………..……………….towards Membership Fee and Subscription
Fee (Annual) for the year…………………………………………………………….…
Authorized Signatory
ICE(I)

APPROVAL TO THE MEMBERSHIP

Membership No. :__________________

Chairman/Secretary
ICE(I)