PE

PE001/Rev02
(For office use)

The Institution of Engineers ( India)

8, GOKHALE ROAD, KOLKATA 700 020
Paste latest
Photograph
APPLICATION FOR PROFESSIONAL ENGINEER (PE)
(FRESH/RENEWAL)
.
(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: Each item to be signed
by at least one
Nationality: nominator after
personal verification.
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: -
………………………………………………………………………………………………….......................

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 1 of 8
Enclose attested photocopies of each of the above certificates
PE001/Rev02

3. Name & Category of membership of related engineering professional institution(s) Each nominator
has to sign one
along with membership no. item after due
verification.
(a)....................................................................................................................................
(b)...................................................................................................................................
(c)....................................................................................................................................
(d)....................................................................................................................................

4. Record of engineering experience in chronological order after passing BE/B.Tech or equivalent.

(if required separate annexure may be added).

Employer/Client Major job responsibilities

Dates Job Title
(if self employed/consultant)

5. Continuous Professional Development Programme(s)/Activities for last five years, starting from current
year. (Refer Annexure - IV)
5.1 Recognised Training Programme(s), Conferences, Seminars, Workshops, Technical Presentations
attended /participated. (Refer format Annexure - I)
“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 2 of 8
 PE001/Rev02

Each nominator 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 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:

Agriculture Aerospace
Architecture Computer
Chemical Civil
Electrical Electronics & Telecommunication
Environmental Mining
Marine Metallurgy & Material

Mechanical Production

Textile

7. Discipline Specialisation (wherever available) : ……………………………………………………...

8. Self-appraisal for certification as Professional Engineer (Refer format Annexure II)

9. Declaration:
(A) CONFORM TO THE CODE OF ETHICS OF THE ECONOMY WHERE I PRACTICE;
(B) BE ACCOUNTABLE FOR ACTIONS WHERE I PRACTICE;
(C) AGREE TO EXCHANGE OF MY DATA AMONGST MEMBERS.
(D) I WISH TO BE CERTIFIED AS PE (I) IN DISCIPLINE AS MENTIONED IN THE APPLICATION FORM.
(E) I AGREE TO ABIDE BY THE CODE OF ETHICS ESTABLISHED FOR PROFESSIONAL ENGINEERS AND TO BE
HELD INDIVIDUALLY ACCOUNTABLE FOR MY ACTIONS.

(F) I HAVE NO OBJECTION AGAINST MY CERTIFICATION PROCESS BEING STOPPED, SHOULD THERE BE ANY
INACCURACY IN THE SUBMITTED INFORMATION.

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 3 of 8
 PE001/Rev02
(G) I HAVE NO OBJECTION AGAINST MY CERTIFICATE BEING TERMINATED AFTER CERTIFICATION ACCORDING
TO PREVAILING RULES ON THE DATE OF TERMINATION AS PROFESSIONAL ENGINEER.
(H) I AGREE THAT THE DECISION ON CERTIFICATION AND TERMINATION SHALL BE BINDING ON ME.
(I) I HEREBY SWEAR THAT THE CONTENTS OF THE ITEMS DESCRIBED IN THIS APPLICAITON ARE TRUE
AND CORRECT.

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

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

Enclosures : 1. Qualification Certificate Nos.

2. Professional Development
Nos.
Programmes’ (CPD) Certificate (s)
3. Bank Draft/Credit Card Rs. DD No.
Authorisation
4. Other please specify

5. Soft Copy of Application in the

form of CD.

Nominations : 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.
To be filled by each Nominator and sent separately confidentially to PE Cell in a sealed envelope (Not
required for renewal applications, Refer format Annexure III)

Sl. Membership No., Grade & Signature

Name
No Name of recognised professional Institution
1.

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 4 of 8
 Annexure - I
The Institution of Engineers (India) PE Cell
Professional Engineers PE002/Rev000
Format for CPD Report

Name:
CPD
Sl.N Applicable Credit hour Outcome of the
CPD Program Weight
o hours obtained Program
Factor

Signature of Candidate

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 5 of 8
 Annexure - II
The Institution of Engineers (India) PE Cell
Professional Engineers PE003/Rev000
Format for Self Appraisal Report
1 Name:
.

2 Qualifications:
.
1.
2.
3.
4.
5.
3 Specialization:
.

4 Core Competencies:
.

5 Design/Patents/Innovation/ Major Project Handled Details:

.

6 Management/Leadership:
.

7 Special Achievements if any:

.

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 6 of 8
 The Institution of Engineers (India) Signature of Annexure
Candidate- III
Professional Engineer PE Cell
Format for Nominator’s Report PE004/Rev000
CONFIDENTIAL
(Not applicable for renewal of certification)
To be filled by each Nominator and sent separately confidentially to PE Cell in a sealed envelope

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 recommend the applicant for certification as Professional Engineer? Ye No
. s
(Please tick)
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.
Engineering qualities and core competencies

a) Innovative

b) Analytical
Ability

c) Problem
Solving
Ability

d) Core
competency

Signature : ……………………………………………………………………………………………………………………………
Name of the Nominator : …………………………………………………………………………………………………………………………….
Correspondence : …………………………………………………………………………………………………………………………….
Address ……………………………………………………………………………………………………………………………
“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 7 of 8
E-mail id : …………………………………………………………………………………………………………………………….
Fellow No. : …………………………………………………………………………………………………………………………….
P Eng No. : …………………………………………………………………………………………………………………………….
Name of the professional institution/society …………………………………………………………………………………………………….
To
PE Cell For more information please visit our website: www.ieindia.org.
4th Floor,(Membership Department) E-mail: [email protected]
The Institution of Engineers (India) Phone: 033 40106232/275
8 Gokhale Road, Kolkata – 700 020 Mob: 8961080218

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 8 of 8
 Annexure - IV
III

 Maximum no. of hours that can be claimed in respect of each of the category of CPD are indicated against each category. CPD hours have to
be claimed from at least 3 categories and total no. of hours claimed from each of the category should not be less than 5 (five) hours.
 Every Professional Engineers will have to plan for a period of five years cycle and will have to cover an average of 75 hours of CPD in each of
the cycle for fresh applicant and 125 for Renewal.
 The record of CPD activity will have to maintain in CPD record book provided by IEI for this purpose.
 The number of Credit Hours will be calculated by multiplying the number of hours actually spent for the CPD activities by a pre-determined
weighted factor.

“Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies” Page 9 of 8