Municipality / Corporation APPLICATION FORM FOR REGISTRATION OF PROFESSIONALS / DEVELOPERS Passport size photo to be affixed and signed across the photo and application Before filling up the application kindly read the instructions given at the bottom. na Name 1 Company/Partnership Firm/Proprietary firm Address (with proof) Email 1D, Mobile No Qualification Experience Identity proof GST No. ©|00|~1) |e] 5) Registration Certificate by Professional bod 4 Registration Fees REGISTRATION FOR (Please tick any one of the appropriate box) Architects - Grade 1- RA Architects — Grade Il- RA Engineers Grade | - RE Engineers Grade Il - RE Engineers Grade Ill - RE Construction Engineer — CE Town Planners - TP Quality Auditor = QA Structural Engineer Grade |- SE ‘Structural Engineer Grade ll - SE Developer — RD [Landscape Architect - LA Geo Tech Engineer - GTE Note: For more than one Registration separate application should be submitted DECLARATION \We hereby declare that /We have gone through the Tamil Nadu Combined Development and Building Rules-2019 specifically duties and responsibilities enunciated in PART V “Registration of Professionals” Rule No.23, read with Annexure XIil and hence \/we obliged that I/we will abide by the enunciated duties and responsibilities strictly. ete section _19.09.2018\08.03.19_ registration certificates. docx 1 bo sla)"Further, I/We hereby declare that the information given here are correct to the belief of my knowledge. SIGNATURE DISCLAIMER (The registration will be cancelled if the above information is found faulty at any point of time) For Office use only: 1 The Official Name and signature | Signature who checked the details | L oe i Name & 1 | Designation_| 2 Registration No Assigned [Professional | Grade! Year | Month | Three | Code Digit | Numeric | I 2019 Instructions to fill up the App! ni form:- 1. All details shall be given in Block Letters only For SI.No.1, if individual, his/her name in Block letter/if Company or Firm Authorized signatory name in Block letters. 3. For SI.No.2, If Company, furnish incorporation certificate with MoA. If partnership firm furnish registered partnership deed 4. For SI.No.3, Give Permanent address for communication. (enclose proof of address) 5. For SI.No.5, Furnish copy of Educational Qualification Certificate 6. For SI.No.6, Fumish copy of experience certificate. 7. For SILNo.7 write the ID number of Aadhar/PAN/Driving License/Passport/Family Card and furnish the copy of it 8. For SI.No.8, Mention the GST number if company/firm, 9. For S1.No.9, write the Registration No. Obtained from the respective professional body and furnish the copy of it 10.For SI.No.10, Registration fee Rs.5000/- shall be remitted in the form of DD (infavor Commissioner, Corporation / Municipality) NEFT/RTGSINet banking in the DANK. esses IS IFS COME IS sasescnsoneeneee 11.For SINo.11, please tick any one of the appropriate box. 12. Furnish three colour passport size photos. One to be affixed in the application form and signed across. The other shall be enclosed along with the application form, eMtp section _19.09.2018\08,03.18_ registration certificates.docxMunicipality / Corporation DEVELOPERS REGISTRATION CERTIFICATE This is to certify that the Company / Partners of Firm / Proprietary Firm / Individual represented by its Managing Director / Partner / Proprietrix Thiru / Tmt. / Mis. has enrolled as Registered Professionals with this Executive Authority / Commissioner, Municipality / Corporation. The Company / Partners of Firm / Proprietary Firm / Individual is Registered as a Registered Professional and given the Registration No. on The Company / Partners of Firm / Proprietary Firm have to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, Registration of Professionals, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.O.(ms) No.18, MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid up to Commissioner Municipality / Corporation Passport Photo | e\tp section 19,09.2018\08.03.19_ registration certificates.dacxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / Mis. has enrolled as Registered Architect Grade-I/Grade-lI (RA) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register No . which is valid till He/She has been given the Registration No. on___. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals", Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.0.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid up to Commissioner Municipality / Corporation Passport Photo ep section _18.09,2018\08.03.19_ registration certiicates.doexpe Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / Ms has enrolled as Registered Engineer Grade-l/Grade-Il/Grade-Ill (RE) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register No... which is valid till ........ He / She has been given the Registration No. on____. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals”, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.O.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid upto Commissioner Municipality / Corporation Passport Photo e-\p section _19.09,2018\08.03.18_ registration cetiicates.docxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / Mis. has enrolled as Structural Engineer Grade-l/Grade-ll (SE) with Executive Authority ! Commissioner, Municipality / Corporation who has the council of Architect Register No.............. which is valid till ..... He / She has been given the Registration No. on___. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals’, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.0.(Ms) No.18 MAWS (MA1) Dept. Dated, 04.02.2019 This Registration is valid up to rd Commissioner Municipality / Corporation Passport Photo e\tp section _19.09.2018\08.03.19_ registration certificates. docxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. J M/s has enrolled as Registered Construction Engineer (CE) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register No........:.... which is valid till He / She has been given the Registration No. on____. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals", Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.O.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid up to Commissioner Municipality / Corporation Passport Photo er\tp section _19,09.2018\08.03.19_ registration certificates dockMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / Mis. has. enrolled as Registered Quality Auditors (QA) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register NOo.............. which is valid till ........ He / She has been given the Registration No. on___. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals”, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.O.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid upto Commissioner Municipality / Corporation Passport Photo e\tp section _19.09.2018\08.03.18_ registration certificates docxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / M/s. has enrolled as Registered Town Planners (TP) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register NO..........44. which is valid till ...... He / She has been given the Registration No. on____. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals”, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.0.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid upto Commissioner Municipality / Corporation Passport Photo tp section _19,09.2018\08.03.19_ registration certificates docxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / Mis, has enrolled as Registered Geo-Technical Engineer (RGTE) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register No.............. which is valid till . He / She has been given the Registration No on____. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals”, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.0.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid upto Commissioner Municipality / Corporation Passport Photo tp section_19.09,2018\08.03.19_ registration certificates docxMunicipality / Corporation PROFESSIONAL REGISTRATION CERTIFICATE This is to certify that the Thiru / Tmt. / M/s. has enrolled as Registered Landscape Architect (LA) with Executive Authority / Commissioner, Municipality / Corporation who has the council of Architect Register NO...ssessesese Which is valid till He / She has been given the Registration No, on___. He/She shall be required to comply with the duties and responsibilities prescribed by the Government of Tamil Nadu in Part V, “Registration of Professionals”, Tamil Nadu Combined Development and Building Rules, 2019 approved vide G.O.(Ms) No.18 MAWS (MA1) Dept. Dated. 04.02.2019 This Registration is valid up to Commissioner Municipality / Corporation Passport Photo tA “AN For Commissioner of Municipal Administration i eAtp section 19.09.2018\08.03.19_ registration certificates.docx t %) aes