APPLICATION FOR MEMBERSHIP

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First Name

Middle Name

Last Name

Son/Daughter/Wife of

Address

City

Pin Code

Mobile No

Phone No. (O)

Phone No. (R)

Personal Details

Date of Birth

Age on date of Application

Nationality

Marital Status

Spouse' Name

Date of Birth of Spouse

Marriage Anniversary

QUALIFICATION

Academic :

Examination Passed

University

Year

Div

Subject

Civil Engineering / Architectural Engineering :

Name of Examination/s Passed

Examining Authority

Full Name and Address of the College/Institution

Year of Passing

Others

Name of Examination

Year

Name of Institution

% Marks/Div./Grade

Membership of other Engineering Institution/Societies (if any) :

Name of Institution/Society

Grade of Membership

Date of election

Whether still a Member

I hereby apply for the membership of APGCE. I do hereby undertake that in the event of my membership confirmed, I will be governed by the bye-laws and the regulations of the APGCE as they now are or as they may hereafter be legally altered and that I will accept as final and binding the decisions of the Executive Council in all matters dealt by them on accordance with the Bye-Laws and Regulations, and will forthwith cease to describe my self as a member of APGCE, or to designate myself as bel

Signature of the applicant (in English only)

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Tick out the boxes to check, whether you have filled in/attached the following particulars along with your application

Application is duly signed by the applicant.

Form is properly supported by supporter of APGCE.

Draft / Payment Slip ` 2000/- only in favour of ''Association Of Professional Graduate Civil Engineers’', payable at VARANASI.

* Attested photo copy of BE/B.Tech./M.E./M.Tech./Ph.D. degree certificate issued by the UniversityVARANASI.

Attested photo copy of the final pass certificate. In case of Provisional certificates, attested photo copy of Final pass mark-sheet indicating all subjects clearly

* Attested photo copy of documentary evidence in support of date of birth.

Attested photo copy of post qualification professional experience details in chronological order

Experience/career details are duly authenticated by employer/one of the supporters

* Attested photocopy of PAN Card

* Attested photocopy of AADHAR Card