Associate and Member

Application Form 2023

Please use black ink and write in CAPITALS. If you require assistance or advice please telephone the IET Services (India) Private Limited Office in Bangalore on +91 80 4089 2222
or email joinus@theiet.in. Your subscription year will run annually from the date that you joined the Institution of Engineering and Technology. To submit your application
by email, print out the completed form, add your signature and send the scanned copy with required attachments to joinus@theiet.in. You can also submit the completed
application form by post to: Membership Application Team, IET Services (India) Private Limited, Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road,
Bangalore, 560 001

Please download form and open with Adobe Acrobat Reader to enable full editable functionality.

Your Details

Personal Details

Title Mr First Name(s) YASEEN KHAN

Surname/Family Name MOHAMMED Date of Birth 04-05-1985

d d m m y y y y

Home Address H NO-19-5-44/A/14/D/6/1, ASAD BABA NAGAR, KISHAN BAGH, BAHADURPURA

District/State HYDERABAD Pin Code 500064 Country INDIA

Home Telephone Personal Mobile 0097430162810

Home Email Address

Preferred name for Membership Card, e.g. Mr S Aggarwal Mr YASEEN KHAN MOHAMMED

Employer Details

Job Title MECHANICAL ENGINEER Employer’s Name ASTAD PMC

Work Address ASTAD HEAD OFFICE, WOQOD TOWER, WEST BAY,DOHA

District/State Doha Pin Code 00 Country INDIA

Work Telephone 0097430162810 Work Mobile 0097430162810

Work Email Address YMECHENG@GMAIL.COM

Please specify the address that you would like all correspondence sent to: Home Work Please specify your gender: Male Female

Membership Number (only required for previous Associates or Members wishing to re-join the IET):

Is your membership fee being funded by your employer? Yes No If yes, please ensure you have completed the work details section above.

Your area of technical expertise DESIGN MANAGEMENT, COSNTRUCTION MANAGEMENT, DESIGN VERIFICATION

Data Protection
I understand and consent to the information provided on this form being processed by the IET for its sole use and that of its associated organisations, including my Local Network, for the purpose
of promoting, delivering and improving my experience of the IET and its product and services or such other purposes as are described in the IET Privacy Statement. If either now or in the future I am
based outside the European Economic Area (the “EEA”), my information may be transferred outside the EEA (for example to my Local Network or IET Global Office) to enable me to benefit from the
IET opportunities overseas or, where required, to enable the IET to meet any legal or other legitimate obligations in that country. IET products and services are enjoyed by our members and customers
globally. If you would like to receive notification of products and services which may be of interest and benefit to you (by post or electronic means) please tick this box.

Declaration
I declare that the statements made on this form are to the best of my knowledge true. I agree to comply with the Royal Charter and Bye-laws and Rules of Conduct of the Institution of Engineering
and Technology (IET) and understand that this is a commitment to behave ethically within my profession. I will do my best to promote the interests of the IET. I confirm that I have not committed any
offence of which the IET would require me to give notice under its Rules of Conduct. The Rules of Conduct and the Royal Charter and Bye-laws are published on the website theiet.org/byelaws

Signature Date 05.12.2023

Membership Category Options

To find out about the requirements for each category of membership visit theiet.org/membership/types

Member Application Section

(Please refer to the guidance notes on the IET website theiet.org/requirements for further guidance in completing this section)

I wish to apply for Member with the designatory letters MIET. I wish to apply for Member with the designatory letters TMIET.
(please complete the Qualifications and Supporter Details sections) (please complete the Qualifications and Supporter Details sections)

I wish to apply for Associate I wish to apply for Associate at the moment.
Please contact me about designatory letters at a later date.

IET Services (India) Private Limited is the appointed distributor of IET products and services in India. IET Services (India) Private Limited regd.
Office Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. GSTIN/UIN: 29AACCI9525K1Z3 PAN: AACCI9525K theiet.in
 Qualifications

Along with the filled application form, please attach a copy of your highest qualification certificate (degree/postgraduate degree/diploma). Please provide details of engi-
neering or technology qualifications you hold or are in the process of completing in the table below (if you are applying for either the Advantage or Signature membership
programme this section must be completed in full):

Award/Course e.g. BTech, Course Title Name of University/College/Awarding Period of Study

MTech, PhD, Diploma etc e.g. Electrical Engineering, Computing etc Body and Country (start and end date)

Btech MECHANICAL ENGINEERING JNTU-HYDERABAD 06/2005-05/2008

Work Experience

Along with the filled application form, please attach an updated copy of your CV. Depending on the Qualification that you hold we may need to assess your work experience
to determine your eligibility for the level of membership selected. Following the assessment of your qualifications, we may contact you to provide further details about your
present employment position, previous employment positions, roles and responsibilities together with any other qualifications that are relevant to the interests of the IET.

Supporter’s Details

Depending on the Qualification that you hold you may need a supporter. Your supporter can be your employer/line manager, a Member of the IET or someone that knows you
in a work capacity e.g. client, previous employer etc.

Title Mr First Name(s) PUMALKUMAR

Surname/Family Name KIZHAKKEVEETIL Job Title MECHANICAL ENGINEER

Line Manager CEng IEng EngTech ICTTech Associate TMIET MIET FIET

Please detail membership of other Institutions e.g. MIMechE, MIEAust:

IET Membership No. (if applicable) 683073

Address for communication KIZHAKKEVEETIL HOUSE, KANAKAMALA PO, CHALAKUDY, KERALA

District/State CHALAKUDY Pin Code 00 Country INDIA

Telephone Mobile 0097433064582
Email Address PUMAL.KUMAR@GMAIL.COM

In my opinion this person has achieved the required knowledge and understanding and is a suitable candidate to become a Member of the IET and use the letters

MIET* or TMIET* after their name (*please select as appropriate)

Signature of Supporter Date 05.12.2023

The IET will contact your supporter for further background to your application for membership. It is not IET policy to disclose comments made by supporters and we would
urge applicants to discuss their membership application with the supporter prior to submission.

IET Services (India) Private Limited is the appointed distributor of IET products and services in India. IET Services (India) Private Limited regd.
Office Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. GSTIN/UIN: 29AACCI9525K1Z3 PAN: AACCI9525K theiet.in
 For office
Payment Options use only:
Name: Membership No.:

IET Services (India) Private Limited sells IET memberships in India. Therefore, when you purchase this membership from IET Services (India) Private Limited you will be awarded
membership of the IET. Subscription rates (inclusive of all taxes and cess) from 1 January 2023 until 31 December 2023 (Fees correct at time of print and subject to change in
January 2024).
*If you graduated within the last year you
are eligible for Graduate Advantage. If you
Associate and Member Standard Rate: ₹7,500/- (Rupees Seven Thousand Five Hundred only) graduated between 1-4 years ago you are
eligible for Career Advantage. If you graduated
Associate and Member Graduate Advantage Rate: ₹1,300/- (Rupees One Thousand Three Hundred only) between 5-6 years ago and are applying for
MIET you are eligible for Professional Advantage
Associate and Member Career Advantage Rate: ₹2,850/- (Rupees Two Thousand Eight Hundred and Fifty only)
Find further information at:
Member Professional Advantage Rate: ₹4,350/- (Rupees Four Thousand Three Hundred and Fifty only) india.theiet.org/advantage

Please select one of the following options:

Enclosed is a cheque / Demand draft crossed at PAR in favour of “IET Services (India) Private Limited” and is payable at Bangalore.
(Please write your Name and Address on the reverse of the cheque.) Note that outstation cheques, cash and money orders cannot be accepted.

Payment by Cash. Note: Please do not send cash through the post. Cash payment can be made by visiting the office in Bangalore, address above.
Bank transfer.
Name: IET Services India Private Limited
A/c No: 912020039155481
IFSC Code: UTIB0000009
Bank: Axis Bank, M G Road, Bangalore
Account type: Current account
Please include your transaction reference with your completed application form.

IET Services (India) Private Limited is the appointed distributor of IET products and services in India. IET Services (India) Private Limited regd.
Office Unit No. 405 & 406, 4th Floor, West Wing, Raheja Towers, M.G. Road, Bangalore, 560 001. GSTIN/UIN: 29AACCI9525K1Z3 PAN: AACCI9525K theiet.in