AM
For Office Use only
Application for Associate Membership (AMIE)
Name : Passport or stamp sized
Last Name Remaining Name photograph to be
In Capitals (As indicated in BE/B.Tech/Equivalent Certificate) pasted here
(Please do not sign on the
photograph)
DETAILS OF PAYMENT
In case of payment by Draft or Cheque:-
D D M M Y Y Y Y
D D M M Y Y Y Y
DETAILS OF BANK ACCOUNT OF THE CANDIDATE (Necessary in cases of refund of Fees)
Account holder’s Name ________________________________________________________________
Name of the Bank & Branch ___________________________________________________________
Account number __________________________________________IFSC No. ___________________
Note:- Please enclose i) Cancelled cheque leaf bearing the Name of A/C holder OR ii) photocopy of
the first page of bank pass book containing name of A/C holder, A/C No., IFS Code
N. B. Filling this part is necessary for photo ID card. Do not
sign/stamp on the photograph.
For Office use only
Name : Passport or stamp sized
Last Name Remaining Name photograph to be
pasted here
In Capitals (As indicated in BE/B.Tech/Equivalent Certificate) (Please do not sign on the
photograph)
Specimen Signature
of the Applicant
(preferably in English)
The signature should not touch the box
(Use black ink only)
Form No. MEMB/03 Page 1
Rev. 09/01042017
Benefits of Corporate Membership (AM/M/F) of IEI
a. Corporate Members are entitled to receive Chartered Engineer certificate on payment of requisite fee.
b. Corporate Members are eligible for exemption from appearing in Section A and may appear directly in
Section B in additional branch examination of IEI.
c. IEI has forged partnership with the globally renowned journal publishing house: SPRINGER. Corporate
Members are entitled to enjoy following benefits regarding IEI journals:-
i) Make free e-access by logging in through www.ieindia.org.
ii) Can avail the journal hard copies at a concessional rate.
d. Corporate Members may access the IEI Library (Engineering Information Service Centre) at the
headquarters as well as State and Local Centres of IEI.
e. Corporate Members are entitled to receive the monthly tabloid 'IEI NEWS' and yearly publication
'TECHNORAMA' free of cost.
f. Opportunity to participate in technical events e.g. Seminars, Symposia, Conventions, Workshops etc.
organized by various IEI centres at State, National and International levels at a concessional rate of
20%.
g. Corporate Members may be empanelled as internal project guide in Section B examination conducted
by IEI, as per norms.
h. Corporate Members may avail the opportunity of staying in the IEI guest houses spread over all
important locations in India. A list of all the guest houses is available at IEI website (www.ieindia.org).
i. Corporate Members employed in Educational Institutes are normally given preference in the
disbursement of grant-in-aid for R&D activities.
j. Corporate Members may participate / contest in IEI elections as per Bye- Laws of the Institution.
Form No. MEMB/03 Page 2
Rev. 09/01042017
The Institution of Engineers ( India)
An ISO 9001:2008 Certified Organisation
AM
8 GOKHALE ROAD, KOLKATA 700 020
Application Form for Associate Member (AMIE)
1.0 Personal Information
Use all Capital Letters within the box without touching the boundaries. Leave one box blank after completing each word
Last Name
Remaining
Name
[As per BE/B.Tech/Equivalent Certificate. If the name differs from the Certificate, please enclose documents as listed in 4.0 (d) of the Annexure]
Father’s/
Husband’s Name
Date of Birth (dd/mm/yyyy)
ADDRESS
Pin Code State Country
Tel (O) Tel (R)
E-mail Mobile
2.0 Educational Qualification
Name of Examinations Year of Branch of Engineering Examining Authority Full Name & Address
Passed (BE/B.Tech, Passing (e.g. Civil, Electrical, (University etc.) of Institute/College
M.Tech or Sec. B of IEI) Computer, etc.)
3.0 Present Position
Present Date of holding Place of Name & Address of the
Designation the Position Posting Present Employer
Military personnel (or ex-servicemen) should mention: i) Present Rank (Last held rank for ex-servicemen), ii) Actual date of commission and
(iii) personal number
Form No. MEMB/03 Page 3
Rev. 09/01042017
4.0 Choice of Engineering Discipline/Division: __________________________________________
Note 1: A Member can’t be attached with more than one Engineering Discipline/Division.
Note 2: An Applicant should not opt for the Engineering Division in which he/she wants to appear as additional branch in
Section B Examination of the Institution.
5.0 Declaration:
1. After having fully understood the Information and instruction as given in the Annexure, I hereby apply for election as an Associate
Member of the Institution of Engineers (India) in accordance with the Charter of Incorporation and the Bye-Laws as they now are at IEI
website www.ieindia.org or as they may be legally altered hereafter.
2. I also do hereby undertake that in the event of my election as an Associate Member, I will be governed by the Bye-Laws and the
Regulations of the Institution as they now are or they may hereafter be legally altered and that I will accept as final and binding the
decisions of the Council in all matters dealt with by them in accordance with the provisions of the Charter, Bye-Laws and Regulations, and
will forthwith cease to describe myself as an Associate Member or to designate myself as belonging to the Institution in any other form, on
receipt of a notice from the Secretary and Director General that acting under the powers conferred upon them by the Bye-Laws and
Regulations the Council have declared myself to be no longer as an Associate Member of the Institution. I further undertake that I will
promote the objects of the Institution, as far as may be in my power, provided that whenever I shall signify in writing to the Secretary and
Director General that I am desirous of withdrawing from the Institution, I shall after the payment of any arrears which may be due by me at
that period be free from this obligation.
3. I have noted that the decision of the Council of the Institution shall be final in granting the Membership and the District Court at Alipore,
24 Parganas (South) shall have the exclusive jurisdiction in settlement of the dispute, if any, arising out of this Membership.
4. I accept the responsibility for the accuracy of the particulars contained in the Application Form with regard to my qualifications and
experience and agree that if I am elected, the validity of my election shall depend upon the accuracy of such particulars as required in the
Bye-Laws.I hereby give my full consent to include my name and contact info as they are now or may be altered hereafter in all the
directories/lists of members as deemed fit by the Institution and also authorise the Institution for publishing it to any individual/organisation
for any purpose whatsoever. I also undertake to abide by Professional Conduct rules and/or Code of Ethics that the Council may frame
from time to time.
Yours Faithfully,
Date: Signature of the Applicant
6.0 Supporter: From personal knowledge of the Applicant and in consideration of his/her qualifications, I recommend
him/her to the Council as being in every way a fit and proper person to be admitted to the Institution as an Associate
Member.
Name Membership No. Signature with date
F/M/AM –
8.0 Application for Chartered Engineer Certificate
I also wish to avail Chartered Engineer Certificate. I have made additional payment (as mentioned in 6.0 of the Annexure) for
the Certificate. Yes / No
Signature of the Applicant
Form No. MEMB/03 Page 4
Rev. 09/01042017
Annexure
AM
IMPORTANT INFORMATION AND INSTRUCTIONS FOR AMIE APPLICANTS
(The pages of Instructions sheet should not be attached with the Application)
For Direct Enrolment (paying in single remittance)
Form No. MEMB/03 Page 1 of 4
Rev. 09/01042017
Engineering Specialization Engineering Division to be attached with
Petroleum, Petrochemical, Biotechnology, Food Technology, Chemical Engineering
Biochemical Engineering, Pulp and Paper Technology, Sugar
Technology, Leather Technology, Plastics & Rubber
Technology, Polymer Engineering, Polymer Science &
Rubber Technology, Oil Technology, Paint Technology
Ceramic Engineering / Technology, Metallurgy & Materials Science
Material Science & Technology
Information Technology Computer Engineering
Instrumentation & Measurement, Instrumentation Electronics & Telecommunication
Engineering/Electrical Engineering
Bio-medical Engineering, Applied Electronics & Electronics & Telecommunication
Instrumentation Engineering Engineering
Industrial Engineering, Automation & Robotics Engineering, Production Engineering
Industrial Engineering and Management, Printing Technology
Power Engineering, Electrical & Electronics Engineering Electrical Engineering
Instrumentation & Control Engineering
Automobile Engineering, Energy Mechanical Engineering
Transportation Engineering Civil Engineering
Form No. MEMB/03 Page 2 of 4
Rev. 09/01042017
Form No. MEMB/03 Page 3 of 4
Rev. 09/01042017
Form No. MEMB/03 Page 4 of 4
Rev. 09/01042017
