Sir,
I beg to apply for admission as an Associate Member/Affiliate Member/Member of
the Indian Institute of Gas Engineers.The required Particulers are furnished
below:
1. Name in full(Block letters)
2. Name in short with surname at the end
3. Father's name
4. Date of birth
5. Nationality
6. Details of Qualifications : a) Educational
b) Professional
7. Permanent residential address
8. Present residential address
9. Occupational/Professional address
10. No. and date of Admission as associate(if applicable)
11. Whether self employed/employed/retired :
i) Name and address of presnt Employer:
ii) Official designation of present employment:
iii) Over all experience(please use separate sheet if required):
I give below the names and addresses of two persons to whom reference
may be made.(One of the referees should be person having personal knowledge
of the applicant's training and experience and one should preferably be
a member of the Institute).
Name Address Business designation and Membership No.,if any
1.
2.
I hereby undertake that if admitted as an Associate Member/Affiliate Member
of the Institute I will be bound by the Rules and Regulations of the Institute
framed/to be framed from time to time.
I also send herewith a sum of Rs_____________being my entrance fee of
Rs____________ and Annual Membership fee of Rs____________for the year
20___ -20___.
Yours faithfully
Place: (Signature)
Date:
____________________________________________________________________________________
Note: 1. Applicants are requested to produce evidence of their age.
2. Original diplomas/ certificates and/ or other documents or attested
copies thereof, in support of the qualifications claimed must be sent.
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