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M E M B E R S H I P No.

)
Engineering College
PIN Code Number

Abbreviated form of the

Engineering College Name

Branch Code

Membership
Serial Number

(Above portion to be filled in by the Adviser of the Chapter)

The Institution of Engineers ( India)

ECSC

8, GOKHALE ROAD, KOLKATA 700 020

The Secretary & Director General

The Institution of Engineers (India)
8, Gokhale Road, Kolkata 700 020

Date ...............................

Dear Sir,
I hereby apply for enrolment as a member of the Students Chapter of The Institution of Engineers (India) in accordance with
the rules of the Chapter and the Bye-laws and Regulations as they now stand or hereinafter be legally altered. I do hereby undertake
that I will be governed by the Bye-laws and Regulations of the Institution. I accept the responsibility for the accuracy of the particulars
contained in the bio-data given overleaf and I agree that, if I am enrolled, the validity of the enrolment shall depend upon the accuracy
of the particulars as required under the Bye-laws. I also undertake to abide by the conduct of rules and/or Code of Ethics that the Council
may prescribe from time to time.
NAME (in block letters)

..................................................................................................
Branch of Engineering

...............................................................................
Signature of the Applicant (in English only)

FOR USE OF HEADQUARTERS OFFICE ONLY

His/Her application is recommended/not recommended for
membership of the Engineering College Students Chapter.

M E M B E R S H I P No.
Engineering College
PIN Code Number

Abbreviated form of the

Engineering College Name

Branch
Code

Membership
Serial Number

(Above portion to be filled in by the Adviser of the

Recommended

Not recommended

............................................................................................................
Dealing Officer (HQ)

Subscription Received

Initial

Rs...................................... for .....................................

(Ist - IVth Year)
Rs...................................... for .....................................
(IInd - IVth Year)
Rs...................................... for .....................................
(IIIrd & IVth Year)
Rs...................................... for .....................................
(IVth Year)

received on .....................................................

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

received on .....................................................

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

received on .....................................................

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

received on .....................................................

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

This portion to be retained by the Student

M E M B E R S H I P No.

M E M B E R S H I P No.

Engineering College
PIN Code Number

Abbreviated form of the Branch

Engineering College Name Code

Membership
Serial Number

(Above portion to be filled in by the Adviser of the Chapter)

Name ..........................................................................
Branch ........................................................................
First/Second/Third/Fourth Year (tick here)
Roll No. ......................................................................

This portion to be retained by the Student

This portion to be retained by the Chapter

Engineering College
PIN Code Number

Branch Code

Membership
Serial Number

(Above portion to be filled in by the Adviser of the Chapter)

The Membership Card is issued to

Affix Passport
Size Photograph

Signature of the Student

Signature of Adviser

Abbreviated form of the

Engineering College Name

as STUDENT of the Institution and is valid up to the year of

his/her completion of study at the Engineering College subject
to renewal each year.
For Secretary & Director General

Signature of the
Student

Signature of Adviser with Seal

P.T.O.

BIO-DATA
1

NAME

Fathers Name / Husbands Name

Mailing Address

PIN
4

Permanent Address

PIN
5

E-mail id/Mobile No.

Date of Birth

Age (as on the day

of Application)

Nationality

Details of Examination Passed :

Examination

D D

M M

Examination Authority

10 At present studying at :
(i)
.................................................. Engineering College
(ii) Address.........................................................................
.......................................................................................
(iii) Semester ...................... Roll/Registration No .................
(iv) Branch...........................................................................

Fee Structure for Members of

Engineering College Students' Chapter
Period
Received
Amount
on
(Rs.)
Ist - IVth Year
185.00
IInd - IVth Year
140.00
IIIrd & IVth Year
95.00
IVth Year
50.00

Roll /Registration No.

Year of Passing

I certify the application for consideration to induct the applicant in IEI

fold as an ECSC Member of IEI.

(Signature of the Adviser of the Engineering College Students Chapter

with seal and date)

The Institution of Engineers ( India)

8, GOKHALE ROAD, KOLKATA 700 020

IEI MEMBERSHIP CARD