Scribd
Upload
82 views2 pages

Amie T To ST

This document contains an application form for upgrading membership from Technician to Senior Technician with the Institution of Engineers India. [1] It requests information such as the applicant's name, existing technician membership number, contact details, diploma details including college and university, and a copy of their final diploma certificate. [2] The applicant must also submit passport photos for an identity card and have their photo and signature verified by an existing Corporate Member. [3] By signing, the applicant accepts responsibility for the accuracy of the information provided and agrees their election will depend on the accuracy of their qualifications.

Uploaded by

Sk.Abdul Naveed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
82 views2 pages

Amie T To ST

This document contains an application form for upgrading membership from Technician to Senior Technician with the Institution of Engineers India. [1] It requests information such as the applicant's name, existing technician membership number, contact details, diploma details including college and university, and a copy of their final diploma certificate. [2] The applicant must also submit passport photos for an identity card and have their photo and signature verified by an existing Corporate Member. [3] By signing, the applicant accepts responsibility for the accuracy of the information provided and agrees their election will depend on the accuracy of their qualifications.

Uploaded by

Sk.Abdul Naveed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

T to ST

An ISO 9001:2008 Certified Organisation


8 Gokhale Road, Kolkata 700 020

Application for Upgradation from Technician to Senior Technician Membership


(Application to be filled in Block Letters)
for Office Use

ICNC No :

Date of Election :

1. Name of the Applicant : ............................................................................................................


(As per Diploma Certificate)

2. Existing Technician Membership No. : T- ........................................

3. Address for Communication : ............................................................................................................


(To be entered in IEI database)
............................................................................................................

............................................................................................................

4. Mobile/Phone No. : (M) .............................................Tel. ..................................................

5. Email : ............................................................................................................

6. (a) Details of Diploma : ............................................................................................................


(Copy of Final Pass Certificate or
Provisional pass Certificate with all ............................................................................................................
semester mark sheet must be
attached duly certified by IEI ............................................................................................................
Corporate Member FIE/MIE/AMIE
only)

b) Name of the College : ............................................................................................................

c) Name of the University/Board : ............................................................................................................

d) Approval No. of AICTE/MHRD : ............................................................................................................

e) Year of Pass : ............................................................................................................

7. a) Old Identity Card Attached : Yes No

b) If no, State the Reason : ............................................................................................................

Copies of Certificates and other documents attested by Corporate Member (FIE/MIE/AMIE only) are enclosed

I accept responsibility for the accuracy of the particulars contained in the application form with regard to my qualification and agree
that if I am elected the validity of my election shall depend upon the accuracy of such particulars.

Date : Full Signature of the Applicant

NB : If the applicant secured exemption of subjects in Section A/B with Technician membership No., separate application should be
sent to Director (EEA) to transfer the marks/grade of such exemption quoting the new Senior Technician (ST) No. after the
upgradation.

1 of 2
T to ST
An ISO 9001:2008 Certified Organisation
8 Gokhale Road, Kolkata 700 020

Proforma for Photo Identity Card

Name : ____________________ __________________________


(in Capitals) [Surname] [Remaining Name]

Specimen Signature of Passport or stamp size


the applicant photograph to be
(Preferably in English) pasted here

(do not sign on the


photograph)
The signature should not touch the box
(Use black ink only)

Supporter : Verified the photograph and signature of the applicant

Name (in Capitals) Membership No. Signature (preferably in English) with date

1. ................................................................................ F/M/AM............................... ...................................................................................

Note : The photograph and signature are to be verified by the existing Corporate Member (FIE/MIE/AMIE only)

Name : ____________________ __________________________


(in Capitals) [Surname] [Remaining Name]

Specimen Signature of Passport or stamp size


the applicant photograph to be
(Preferably in English) pasted here

(do not sign on the


photograph)
The signature should not touch the box
(Use black ink only)

2 of 2

You might also like