PE APE Registration Form
PE APE Registration Form
Registration of
Professional Engineer (PE) /Associate Professional
Engineer (APE)
APPLICATION FORM
Serial No. ______________
1.
1.1
Personal Particulars
Name (In Capital Letters)
Paste Latest
Passport size
Photograph
Place of Birth
___________________
Nationality
1.3 Male
Female
1.4 Single
Married
1.5: Present Organisation/ Work Place Name and Address with Pin code:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Present Position in Organisation/Work
Place_____________________________________________________________
Tel.
____________________________________
Fax ______________________________________________
E-mail:
____________________________________________________________________________________________
1.6 Residential Address
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Tel.
Mob
Emai: __________________________________________________________________________________________
Organisation Address
Disciplines/Major Subjects
Year of
Completi
on
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
________________________________________ __________
________________________________________ __________
___________________ _________________________
________________________________________ __________
___________________ _________________________
________________________________________ __________
Duration
Nature of Participation
Conducting Organisation
Date
Subject
by/Conducted at
Published
6. Professional Experience
Describe your experience in the following format, for each period of your employment /
involvement in retrospective order i.e. starting from present position in descending sequence. If
self-employed, write self-employed under Position, and give details of experience. Please also
underline the experience in a responsible position of significant engineering activity.
From
to
Position
Organisation
Brief Description
7.
8.
___________________________________
__________________________________ ______________________________
9. Registration Fees- Bank transfer/draft/Pay order in the name of Engineering Council of India
(Account details will be given on request)
Amount in Rs.
Bank
dated
10. Declaration:
I agree to abide by, the professional Code of Ethics established by Engineering Council of India,
and to be held individually accountable for my action.
I undertake to send reports of Professional Experience and Continuing Professional
Development as on 31st March of each following year regularly so as to reach ECI by 30 th June.
I agree that decision of the ECI on Registration and Termination shall be binding on me.
I hereby confirm that the contents of the items described in this application documents are
true and correct.
Enclosures:
1.
2.
3.
4.
Date: dd/mm/yyyy:
________________________