PE Rev- 13
(For office use)
The Institution of Engineers ( India)
8, GOKHALE ROAD, KOLKATA 700 020
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APPLICATION FOR PROFESSIONAL ENGINEER
(FRESH/RENEWAL)
PART I
(To be filled by the applicant in his/her handwriting using black ink only)
(Please refer to the Guidelines for Applicants before filling up the form)
1. Name in block letters: First
Middle
Last
Son/Daughter/Wife of
Address in block letters
City in block letters
Pin
State in block letters
E-mail id: .................................................................... Tele No (.........)................
D D
M M Y YY Y
Mobile No...............................................
Date of Birth:
Each item to be signed
by at least one
nominator
after
personal verification
Nationality:
2. Academic Qualifications:
BE / B. Tech or Equivalent
Discipline
University
Year of Passing
ME / M Tech or Equivalent
Discipline/Specialisation
University
Year of Passing
Discipline/Subject
University
Year of Passing
Ph D or Equivalent
Any other non-engineering Post Graduation professional qualifications:
...........................................................................................................................................................................
...........................................................................................................................................................................
Field of specialisation in engineering, if any: .......................
Enclose attested photocopies of each of the above certificates
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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[Link] & Category of membership of engineering related professional institution(s).
(a)....................................................................................................................................
(b)...................................................................................................................................
(c)....................................................................................................................................
(d)....................................................................................................................................
Each nominator
has to sign one
item after due
verification.
[Link] of engineering experience since graduation in chronological order. (Ref. item 4.1 of Guidelines)
Dates
Employer/Client
Job Title
Major job responsibilities
(if self employed/consultant)
5. Professional Development Programme(s)/Activities for last five years, starting from current year.
5.1 Recognised Training Programme(s), Conferences, Seminars, Workshops, Technical Presentations
attended /participated.
Sl. No.
Title/Subject
Duration & Dates
Nature of Participation
Conducting
Organisation
1.
2.
3.
4.
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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Each nominator is
expected to sign at
least one item after
due verification.
5.2 Books/Articles/Research/Technical Reports written by applicant
Title
Date of Finalisation
Published by/Submitted to
5.3 Professional contributions in emergency works (e.g. Flood Relief, Earthquake, Fire Fighting etc.)
Enclose supporting documents for Sl No. 5.
6. Discipline of Professional Engineer applied for:
Civil
Electrical
Chemical
Mining
Mechanical
Electonics &
Telecommunication
Textile
7. Assessment Examination, if applicable (Ref. Item 6 of Guidelines)
Yes
No
7.1 Choice of Examination Centre Code
7.2 Discipline Specialisation (wherever available)
(Please see Assessment Examination in [Link] for the available specialisations in
Module 2 (Part II) and choice of Examination Centre)
7.3 Examination fee Rs.4000/- or US$ 400 (for applicants other than citizen of India & Nepal) to be
given by Demand Draft
(An additional fee of Rs.3000 towards interview by electronic media will be required to pay by the applicant
after successful completion of PE online assessment examination)
8. For Renewal of PE Certification
Yes
No
Rs. 3000/- or US$ 300 (for applicants other than citizen of India & Nepal) to be paid towards the fee for renewal
of PE Certification with an additional amount of Rs.3000/- towards the fee for appearing in the interview
through electronic media.
[N.B.: - For upgradation from PE (India) to IntPE (India) a separate application form is required to be
filled up, which is available in the website, the applicable fee for upgradation to IntPE (I) register is
Rs.10, 000/- or US$ 500 (for applicants other than citizen of India & Nepal).]
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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9. Self-appraisal for certification as Professional Engineer (Refer item 4/6.5(a) of Guidelines as
applicable) (Attach separate sheet)
10. Declaration:
_
I wish to be certified as Professional Engineer in discipline as mentioned in the
application form.
I agree to abide by the Code of Ethics established for Professional Engineers and to
be held individually accountable for my actions.
I have no objection against my certification process being stopped, should there be
any inaccuracy in the submitted information.
I have no objection against my certificate being terminated after certification
according to prevailing rules on the date of termination as Professional Engineer.
I agree that the decision on Certification and Termination shall be binding on me.
I hereby swear that the contents of the items described in this application documents
are true and correct.
Date :
Applicants Signature ........................................
Applicants Name ..............................................
Nos.
Enclosures :
1. Qualification Certificate
2. Professional Development
Programmes Certificate (s)
3. Bank Draft/Credit Card
Authorisation
4. Others
Rs.
DD No.
Nominations : From personal knowledge of the applicant and in consideration of his/her qualifications as stated in the form,
we recommend him/her as being in every way a fit and proper person to be certified as Professional Engineer.
(Not required for renewal applications.) (Ref. Item 5 of Guidelines)
Name
Membership No., Grade &
Name of recognised professional Institution
Signature
1.
2
3.
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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Continuous Professional Development
Classification
Type
Formal
Education
Upgrade
In
Engineering/
Management
duly
recognized by BFC (Upper
limit)
Formal
Education
Upgrade in Engineering/
Management
duly
recognized by BFC
(Upper limit)
Formal Education
Training Activities
limit)
and
(No
(1)
(2)
CPD Weight
Factor
(Multiplier)
Applicable CPD
Program
Doctorate
_____________
Post
Graduate Degree
___________________
_________
Post Graduate Diploma
___________________
_________
Post
Graduate
Correspondence/ online
course (including those
gained through the
internet)
___________________
_________
Authorising books in
field of specializations
published by a reputed
publisher
___________________
(3)
1.
2.
3.
(4)
Participation in CPD
related
lectures,
symposium, in-house
training, studying tour,
National
and
International
conferences etc.
(5)
Lecturer or Symposium
Panelist
2
2
Applicable
Hours
30
25
20
Annexure - I
Credit Hours
Obtained
__________
__________
Participation in
academic meeting
an
(7)
Writing thesis, technical
reports and others
__________
20
__________
Attending a committee
etc.
(9)
Part of Professional
contribution in activities
such as emergency risk
judgement work.
All
achievements
shall be supported
with records and
certificates.
Limit for total of all =
60 hrs for 5 years
20
Actual
hours
of
attendance
0.5
Actual
hours
of
attendance
__________
__________
Presentation Papers and
other Activities (No limit)
(8)
All
achievement
shall be supported
with records and
certificates.
Limit for total of all =
60 hrs for 5 years
Actual lecture
hours
____________
(6)
Remarks
Hours spent
at
an
academic
meeting
Actual hours
to write a
report
Hours
of
attendance
Hours spent
for
professional
contribution
Lectures
exclude
routine teaching at
institutions
and
university
____________
____________
______________
____________
______________
______________
__________
Subject to limit of 20
hours per year
This is applied only
when an applicant
participates in active
discussions (such as
at roundtable)
Only those with
urgency and in the
public interest such
as
emergency
building
risk
judgement
work
after earthquake etc.
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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PART II
(To be filled by National Committee)
1. Passed Professional Engineer Assessment Examination
(a) Examination
[Link] No............................ Date of Passing
(b) Experience including Continuous Professional Development
Date of Interview ....................................................
Assessment (in brief) ..................................................
..
..
..
2. Conducted by member association
3. Recommendations for Certification as Professional Engineer
Yes
No
If yes, state discipline recommended
Discipline .................................
Reference No............................
Date..........................................
________
Signature
___________________________
Authorised Signatorys designation
_______________________________
Name of professional engineering association
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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PART III
(For IEIs use only)
Verification
Certification Approved / Not approved
Discipline .................................................... Registration No.............................................
Date of intimation of Certification to the applicant
Date of despatch of Professional Engineer Certificate
________
Signature
_________________________
Authorised Signatorys Designation
for Board for Certification of Professional Engineer
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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(CONFIDENTIAL)
(Not applicable for renewal of certification)
To be filled by each Nominator and sent separately to BFC in a sealed envelop
(Ref. Item 5 of Guidelines)
Report on Shri/Smt
1.
How long have known the applicant?
2.
In what capacity?
3.
. Years
Employer
Sr. Colleague
Mentor
Colleague
Friend
Client
Do you recommended the applicant for certification as Professional Engineer
Yes
No
4.
If yes please give your own impression of the candidate and why you consider him/her a fit person to
be certified as professional engineer, identifying his/her engineering qualities & achievement (around 50
words)
Signature: ...
Name of the Nominator: ..
Correspondence Address
.
E-mail id :
Fellow No.: .
P Eng No.: ..
Name of the professional institution/society .
To
Board for Certification of Professional Engineer
The Institution of Engineers (India)
8 Gokhale Road
Kolkata 700 020
For more information please visit our website: [Link] through home page Professional Engineer.
E-mail: ddg@[Link] / pe@[Link]
Phone: 033 2223-3296
Please necessarily submit the softcopy of this application in the form of CD along with the hardcopies.
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