IIESL

	APPLICATION FOR MEMBERSHIP	ISO 9001: 2015
	SOP / REG / F1

FORM NO: IIESL/MEM/01

INSTITUTION OF INCORPORATED ENGINEERS, SRI LANKA

ESTABLISHED IN 1977, INCORPORATED BY ACT OF PARLIAMENT (ACT NO: 64 OF 1992 & AMENDED BY CT NO:11 OF 2000) OF DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA.

LIC OF SRI LANKA. No.27/B, Udumulla Road, Battaramulla

Tele: 0112 887734 Fax: 2887737 Email: iiesl@iiesl.lk Website: www.iiesl.lk

APPLICATION FOR MEMBERSHIP

SECTION 1: PERSONAL DATA ABOUT THE CANDIDATE

1.1 Full Name

Profile Picture

1.2 Permanent Address

Province

District

1.3 Official Address

1.4 Preferred Postal Address

Official Address

Permanent Address

Contact Details

Tel:

Mobile:

Office:

Email 1:

Email 2:

1.5 Sex

Male

Female

1.6 Civil Status

1.7 National Identity Card Number

1.8 Date of Birth

1.10 Class of Membership Applied for

SECTION 2 : DETAILS OF EDUCATION

2.1 General Education

School Attended

Highest Educational Level Reached

From Year

From Month

To Year

To Month

2.2 Engineering Education

Institution

Course of Study

Field of Engineering

Please Specify Other Field

From Year

From Month

To Year

To Month

2.3 In-Plant Training (if applicable) / or any other special training in lieu of In-plant Training

From Year

From Month

To Year

To Month

Place/ Establishmen

Nature of Training

SECTION 3 : DETAILS OF EXPERIENCE

Institution / Establishment

Nature of Work

Designation

From Year

From Month

To Year

To Month

SECTION 5: CONTINUING PROFESSIONAL DEVELOPMENT RECORD

I hereby certify that the particulars in this application and related documents furnished by me are true and correct. I am aware that if the particulars contained herein or the related documents are found to be false or incorrect, I am liable to be disqualified before the election to the applied class of membership and for cessation after the election at any instant. Further, I am aware that the excess payments made or deposited will not be refunded by the Institution.

SECTION 6: PROPOSER & SECONDER

PROPOSER

Membership Number

Please enter the membership number and click the 'Search' button to verify the proposer details before submitting the form.

SECONDER

Membership Number

Please enter the membership number and click the 'Search' button to verify the seconder details before submitting the form.

Email Verification

Verify Your Email Address

Please confirm your email address: