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

The Institution of Engineers ( India)

8 GOKHALE ROAD, KOLKATA 700 020 Original
Tel No. (IVRS) : (033) 40155400, Fax No. (91)(033) 2223-8345, E-mail : membership@ieindia.org
(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
The signature should not touch the box (do not sign on the
(Use black ink only) photograph)
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. Signature (in English only) with date

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

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)
Passport or stamp
size photograph to be
pasted here
The signature should not touch the box (do not sign on the
photograph)
Signature * Attested (Use black ink only)
* 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. Signature (in English only) with date

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

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