application form-profession engineer from iei

7/21/2019 Application Form-Profession Engineer from IEI

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“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.” of 8

PE Rev- 13(For office use)

The Institution of Engineers ( India)8, GOKHALE ROAD, KOLKATA 700 020

APPLICATION FOR PROFESSIONAL ENGINEER

(FRESH/RENEWAL)

PART I(To be filled by the applicant in his/her handwriting using black ink only)

( Please refer to the ‘Guidelines for Applicants’ before filling up the form)

1. Name in block letters: First Middle Last

Son/Daughter/Wife of

Address in block letters

City in block letters Pin

State in block letters

E-mail id: …...................................................................……………. Tele No (........….)...............…………….D D M M Y Y Y Y Mobile No...............................................

Date of Birth:

Nationality:

2. Academic Qualifications:

BE / B. Tech or Equivalent Discipline University Year of Passing

ME / M Tech or Equivalent Discipline/Specialisation University Year of Passing

Ph D or Equivalent Discipline/Subject University Year of Passing

Any other non-engineering Post Graduation professional qualifications:......................................................................................................................................................................................................................................................................................................................................................Field of specialisation in engineering, if any: -

………………………………………………………………………………………………….......................Enclose attested photocopies of each of the above certificates

Paste latest

Photograph

Each item to be signedby at least onenominator afterpersonal verification




3.Name & Category of membership of engineering related professional institution(s).

(a)....................................................................................................................................(b)...................................................................................................................................(c)....................................................................................................................................(d)....................................................................................................................................

4.Record of engineering experience since graduation in chronological order. (Ref. item 4.1 of Guidelines)

Dates Employer/Client(if self employed/consultant)

Job Title Major job responsibilities

5. Professional Development Programme(s)/Activities for last five years, starting from current year.

5.1 Recognised Training Programme(s), Conferences, Seminars, Workshops, Technical Presentationsattended /participated.

Sl. No. Title/Subject Duration & Dates Nature of ParticipationConductingOrganisation

1.

2.

3.

4.

Each nominatorhas to sign oneitem after due

verification.




5.2 Books/Articles/Research/Technical Reports written by applicant

Title Date of Finalisation Published by/Submitted to

5.3 Professional contributions in emergency works (e.g. Flood Relief, Earthquake, Fire Fighting etc.)

Enclose supporting documents for Sl No. 5.

6. Discipline of Professional Engineer applied for:

Civil Electrical

Chemical Mining

Mechanical Electonics &Telecommunication

Textile

7. Assessment Examination, if applicable (Ref. Item 6 of Guidelines)

7.1 Choice of Examination Centre Code

7.2 Discipline Specialisation (wherever available)

(Please see ‘Assessment Examination’ in www.ieindia.org for the available specialisations in

Module 2 (Part II) and choice of Examination Centre)

7.3 Examination fee Rs.4000/- or US$ 400 (for applicants other than citizen of India & Nepal) to begiven by Demand Draft

( An additional fee of Rs.3000 towards interview by electronic media will be required to pay by the applicantafter successful completion of PE online assessment examination)

8. For Renewal of PE Certification

Rs. 3000/- or US$ 300 (for applicants other than citizen of India & Nepal) to be paid towards the fee for renewalof PE Certification with an additional amount of Rs.3000/- towards the fee for appearing in the interview

through electronic media.

[N.B.: - For upgradation from PE (India) to IntPE (India) a separate application form is required to befilled up, which is available in the website, the applicable fee for upgradation to IntPE (I) register isRs.10, 000/- or US$ 500 (for applicants other than citizen of India & Nepal).]

Each nominator isexpected to sign atleast one item afterdue verification.

Yes No

NoYes




9. Self-appraisal for certification as Professional Engineer (Refer item 4/6.5(a) of Guidelines asapplicable) (Attach separate sheet)

10. Declaration:

_ I wish to be certified as Professional Engineer in discipline as mentioned in theapplication form.

_ I agree to abide by the Code of Ethics established for Professional Engineers and tobe held individually accountable for my actions.

_ I have no objection against my certification process being stopped, should there beany inaccuracy in the submitted information.

_ I have no objection against my certificate being terminated after certificationaccording to prevailing rules on the date of termination as Professional Engineer.

_ I agree that the decision on Certification and Termination shall be binding on me.

_ I hereby swear that the contents of the items described in this application documentsare true and correct.

Date :Applicant’s Signature ........................................

Applicant’s Name ..............................................

Nos.Enclosures : 1. Qualification Certificate

2. Professional DevelopmentProgrammes’ Certificate (s)

3. Bank Draft/Credit CardAuthorisation

4. Others

Nominations :

Name Membership No., Grade &Name of recognised professional Institution

Signature

1.

2

3.

Rs. DD No.

From personal knowledge of the applicant and in consideration of his/her qualifications as stated in the form,we recommend him/her as being in every way a fit and proper person to be certified as Professional Engineer.(Not required for renewal applications.) (Ref. Item 5 of Guidelines)




ClassificationType

Applicable CPDProgram

CPD WeightFactor

(Multiplier)

ApplicableHours

Credit HoursObtained

Remarks

Formal Education

UpgradeIn Engineering/Management dulyrecognized by BFC (Upperlimit)

(1)

Doctorate_____________

PostGraduate Degree____________________________

Post Graduate Diploma____________________________

2

2

2

30

25

20

__________

__________

__________

All achievement

shall be supportedwith records andcertificates.

Limit for total of all =60 hrs for 5 years

Formal EducationUpgrade in Engineering/Management dulyrecognized by BFC(Upper limit)

(2)

Post GraduateCorrespondence/ onlinecourse (including thosegained through theinternet)____________________________

Authorising books infield of specializationspublished by a reputedpublisher___________________

1

2

20

20

__________ All achievementsshall be supportedwith records andcertificates.

Limit for total of all =60 hrs for 5 years

Formal Education andTraining Activities (Nolimit)

(3)1.2.3.

1Actualhours ofattendance __________

(4)

Participation in CPDrelated lectures,

symposium, in-housetraining, studying tour,National andInternationalconferences etc.

0.5 Actualhours ofattendance

__________

Presentation Papers andother Activities (No limit)

(5)Lecturer or SymposiumPanelist

2Actual lecturehours

____________

Lectures excluderoutine teaching atinstitutions anduniversity

(6)Participation in anacademic meeting

1

Hours spentat anacademicmeeting

____________

(7) Writing thesis, technicalreports and others

1 Actual hoursto write areport ____________

Subject to limit of 20hours per year

(8)Attending a committeeetc.

1Hours ofattendance

__________________________

This is applied onlywhen an applicantparticipates in activediscussions (such asat round–table)

(9)

Part of Professionalcontribution in activitiessuch as emergency risk

judgement work.

1

Hours spentforprofessionalcontribution

______________________________________

Only those withurgency and in thepublic interest suchas emergencybuilding risk

judgement workafter earthquake etc.

Continuous Professional Develo ment Annexure - I




PART II

(To be filled by National Committee)

1. Passed Professional Engineer Assessment Examination

(a) Examination

Discipline…………………….Roll No............................ Date of Passing……………………

(b) Experience including Continuous Professional Development

Date of Interview ....................................................

Assessment (in brief) ................................................………………………..………………………………………………………………………………..………………………………………………………………………………..………………………………………………………………………………..

2. Conducted by member association ………………………………………………

3. Recommendations for Certification as Professional Engineer

If yes, state discipline recommended

Discipline ...............................…………..

Reference No..........................…………..

Date........................................…………..

________

Signature

___________________________Authorised Signatory’s designation

_______________________________Name of professional engineering association

Yes No




PART III

(For IEI’s use only)

Verification

Certification Approved / Not approved

Discipline .................................................... Registration No.............................................

Date of intimation of Certification to the applicant

Date of despatch of Professional Engineer Certificate

________Signature

_________________________Authorised Signatory’s Designation

for Board for Certification of Professional Engineer




(CONFIDENTIAL)

(Not applicable for renewal of certification)

To be filled by each Nominator and sent separately to BFC in a sealed envelop(Ref. Item 5 of Guidelines)

Report on Shri/Smt………………………………………………………

1. How long have known the applicant? ………. Years

2. In what capacity? Employer Sr. Colleague Mentor

Colleague Friend Client

3. Do you recommended the applicant for certification as Professional EngineerYes No

4. If yes please give your own impression of the candidate and why you consider him/her a fit person tobe certified as professional engineer, identifying his/her engineering qualities & achievement (around 50words)

Signature: ……………………………………………………………...Name of the Nominator: ………………………………………………..Correspondence Address ………………………………………………

……………………………………………….

E-mail id : ………………………………………………

Fellow No.: …………………………………………………….P Eng No.: ……………………………………………………..

Name of the professional institution/society …………………………….

ToBoard for Certification of Professional EngineerThe Institution of Engineers (India)8 Gokhale RoadKolkata – 700 020

For more information please visit our website: www.ieindia.org through home page Professional Engineer.E-mail: [email protected] / [email protected]: 033 2223-3296

application form-profession engineer from iei

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