Prime Membership Application Form (Fill with All Capital Letters)

Type of Membership Applied:

Name:
Paste Here
Father’s Name: Passport Size
Photo
Date of Birth: / / Gender: Male Female

Address with Pin code:

City: State: Pin code:

Email: Mobile/ Whatsapp no.:

Education Qualification:

Qualification Education Name Year of Passing

Diploma / Degree

Pan No.: Year of Passing:

Document Attached –(Self Attached )

Degree/Diploma Certificate Post Graduate Degree Certificate PAN Card

Adhaar Card

Institutional Membership Form /Any other:

Payment Details

Cheque/DD No. Amount Rs. /- Date:

Bank Branch:

In the favor of “Council of Engineers and Valuers” Payable at Indian Bank HMV College Road, Jalandhar .
Account No. :6570661490 IFSC Code: IDIB 000H048

Undertaking:-
In the event of my selection as member of the “Council of Engineers & Valuers”, I promise to abide by the constitution,
The code of ethics and bye-laws of the “Council of Engineers & Valuers”, I declare the particulars given above are true
and correct to the best of my knowledge & all the educational certificates are Genuine and valid on date.

Sign of Applicant: Membership Approved

(Authority signature)

Administrative Office : 210 Dayal Nagar, Near Ashok Nagar, Jalandhar-144001, Punjab, India. Page 1
Mobile : +91 9041 263 607 Email : cevajalindia@gmail.com Website : www.ceviaf.org
 UNDERTAKING
I son/daughter/wife of

RIO , do here by undertakes & declares as follows:

1. That I will not act against the interest of this association and my profession.
2. That I shall abide by rules and regulation of “Council of Engineers and Valuers” (Regd)
in the true spirit all the time.
3. That all the information provided here is true and nothing is concealed herein.
4. That I shall abide the decision of CORE COMMITTEE of “COUNCIL OF ENGINEERS AND VALUERS” to
enroll/reject me as a member and the decision shall be acceptable on me at all times.
5. That if at any time, my activities in professional capacity are found to be against the moral interests. And
motivates of “Council of Engineers and Valuers” (Regd) the core committee is at liberty to expel my
membership and the decision shall be binding on me.
6. That I have completed my Diploma / Degree/ Degree in Engineering/ Architecture/ Town Planning as Regular
course approved by UGC / AICTE and it is not through distance education program and I shall be responsible if it
is challenged by any court of law.
7. That the membership certificate is the property of “COUNCIL OF ENGINEERS AND VALUERS” (Regd)
And I shall return in the case I am expelled from membership of this association for whatsoever reason.
8. Should there be any dispute I shall try to resolve the dispute in mutual trust and goodwill with in bye laws of
Council of Engineers and Valuers and jurisdiction of all matters training to my membership shall be at Jalandhar
City.
9. I hereby declare that I am not declared unfit for any misconduct for my professional capacity by any court and
will be personally responsible for any such type of misconduct at my end.

Date:

Place: Candidate Signature

FOR OFFICE USE BY LOCAL CHAPTER
Name Yes/No Signature Name Yes/No Signature

HEAD OFFICE
Name Yes/No Signature Name Yes/No Signature

Administrative Office : 210 Dayal Nagar, Near Ashok Nagar, Jalandhar-144001, Punjab, India. Page 2
Mobile : +91 9041 263 607 Email : cevajalindia@gmail.com Website : www.ceviaf.org