PE Rev- 08

(For office use)

THE INSTITUTION OF ENGINEERS (INDIA)
8, GOKHALE ROAD, KOLKATA 700 020
Paste latest
APPLICATION FOR PROFESSIONAL ENGINEER photograph
PART I
(To be filled by the applicant in his/her handwriting using black ink only)

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 :
Each item to be
signed by at least one
Nationality : sponsor after personal
verification
2. Academic Qualifications:
BE / B. Tech Discipline University Year of Passing

ME / M Tech Discipline/Specialisation University Year of Passing

Ph D 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

IE(India): Feb 09 Page 1 of 7

3. Name & Category of membership of engineering related professional institution(s). Each sponsor
has to sign one
(a).................................................................................................................................... item after due
(b)................................................................................................................................... verification.

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

Dates Employer/Client Job Title Major job responsibilities

(if self employed/consultant)

Attach additional sheets if more space is required.

5. Professional Development Programme(s)/Activities for last five years, starting from current year.
5.1 Recognised Training Programme(s), Conferences, Seminars, Workshops, Technical
Presentations attended /participated.

Sl. Title/Subject Duration & Dates Nature of Participation Conducting

No. Organisation
1.

2.

3.

4.

Attach additional sheets if required.

IE(India): Feb 09 Page 2 of 7

 Each sponsor is
expected to sign at
least one item after
5.2 Books/Articles/Research/Technical Reports written by applicant due verification.

Title Date of Finalisation Published by/Submitted to

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

Enclose supporting documents for Sl No. 5.

6. Discipline of Professional Engineer applied for :

Civil Electrical

Electronics & Telecomm. Computer /Inform Tech

Chemical Metallurgy & Material Sciences

Mining Aerospace/Aeronautical

Marine Textile

Agricultural Production

Environmental Mechanical

Bio-Engineering Architectural Engg

Industrial Petroleum Engg/Technology

Any other

IE(India): Feb 09 Page 3 of 7

 7. Assessment Examination, if applicable (Ref. Item 6.5.8 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)
8. Self-appraisal for certification as Professional Engineer (Ref. item 4 /6.5(a) of Guidelines
as applicable) (Attach separate sheet)
9. Declaration:
_ I wish to be certified as Professional Engineer in discipline as mentioned in the
application form.
_ I agree to abide by the Code of Ethics established for Professional Engineers and to
be held individually accountable for my actions.
_ I have no objection against my certification process being stopped, should there be
any inaccuracy in the submitted information.
_ I have no objection against my certificate being terminated after certification
according 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 documents
are true and correct.
Date :
Applicant’s Signature ........................................

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

Nos.
Enclosures : 1. Qualification Certificate(s)
2. Professional Development
Programmes’ Certificate(s)
3. Bank Draft/Credit Card Rs, No.
Authorisation
4. Others
Sponsors : (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 ( Ref. item 5 of Guidelines)

Name Membership No., Grade & Signature

Name of recognised professional Institution
1.
2
3.

IE(India): Feb 09 Page 4 of 7

 PART II

(To be filled by National Committee)

1. Passed Professional Engineer Assessment Examination

(a) Examination

Roll No................................................... Date of Passing .................................

(b) Experience Assessment including Continuous Professional Development

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

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

………………………………………………………………………………..
………………………………………………………………………………..
………………………………………………………………………………..

2. Conducted by host Institution/ Association ………………………………………………

3. Recommendations for Certification as Professional Engineer

Yes No

If yes, state discipline recommended

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

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

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

________
Signature

___________________________
Authorised Signatory’s designation

_______________________________
Name of professional engineering association

IE(India): Feb 09 Page 5 of 7

 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

IE(India): Feb 09 Page 6 of 7

 (CONFIDENTIAL when completed)

(Not applicable for renewal of certification)

To be filled by each Sponsor 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 Engineer

Yes No

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

Signature: ……………………………………………………………..

Name of the Sponsor: ………………………………………………….

Correspondence Address ………………………………………………

………………………………………………

E-mail id : ………………………………………………

Fellow No./P Eng No…………………………………………………..

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

To
Board for Certification of Professional Engineer
The Institution of Engineers (India)
8 Gokhale Road
Kolkata – 700 020

IE(India): Feb 09 Page 7 of 7