Please return the application duly filled in (both Original and Duplicate)

The Institution of Engineers ( India)

8 GOKHALE ROAD, KOLKATA 700 020
Tel No. (IVRS) : (033) 40155400, Fax No. (91)(033) 2223-8345, E-mail : membership@ieindia.org

Original

(Application For Issuance of Photo Identity Card)

Dear Sir,
Please find enclosed a draft of Rs. 250/- (US $ 25 for members residing/working in abroad) towards the fee for Photo
Identity Card.
Please arrange to issue me the Photo Identity Card.
Signature ____________________________________
Encl : Draft No. __________________

For Office Use

Name in Capitals

[Surname]

[Remaining Name]

Membership No. A/AM/M/F ____________ - ___

Mobile No. ______________

Specimen Signature
(* in English only)
Passport or stamp
size photograph to be
pasted here
(do not sign on the
photograph)

The signature should not touch the box

(Use black ink only)

Signature * Attested

* In case of regional language, signature attestation is a must by a

Gazetted Officer with Seal

Supporter : Verified the photograph and signature of the applicant

Name (in Capitals)

Membership No.

1.................................................................

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

Signature (in English only) with date

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

Note : The Photograph and signature are to be verified by the supporter who is an existing Corporate Member (F/M/AM).

The Institution of Engineers ( India)

8 GOKHALE ROAD, KOLKATA 700 020
Tel No. (IVRS) : (033) 40155400, Fax No. (91)(033) 2223-8345, E-mail : membership@ieindia.org

Duplicate

(Application For Issuance of Photo Identity Card)

For Office Use
Name in Capitals

[Surname]

[Remaining Name]

Membership No. A/AM/M/F ____________ - ___ Mobile No. ______________

Specimen Signature
(* in English only)

The signature should not touch the box

Signature * Attested

(Use black ink only)

Passport or stamp
size photograph to be
pasted here
(do not sign on the
photograph)

* In case of regional language, signature attestation is a must by a

Gazetted Officer with Seal

Supporter : Verified the photograph and signature of the applicant

Name (in Capitals)
1.................................................................

Membership No.
F/M/AM .............................................

Signature (in English only) with date

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

Note : The Photograph and signature are to be verified by the supporter who is an existing Corporate Member (F/M/AM).