The Instituteof MarineEngineers (India)

Plot No. 94, Sector-19, Nerul, Navi Mumbai, Maharashtra 400706

Tel : +91-022 2770 1664/ 022 2770 6749, Email:,Website:

FORM : E 2005-01

APPLICATION FOR ELECTION TOMEMBERSHIP

PLEASE FILL IN BLOCKLETTERS

SECTION A : PERSONALDETAILS

Head Office: 1012Maker Chamber-V, Nariman Point, Mumbai- 400 021.Tel.: +91-22-2283 4035, Fax: +91-22-2283-4035

Name (infull)

FirstnameMiddlename/sSurname

Please tick ❒MaleFemaleDate of Birth:

DDMMYYYY

Address : Office:

StatePin Code

Res.:

StatePin Code

Telephone : Office : Res :

Fax: Office : Res :

E-mail: Office :Mobile No:

It is essential that your permanent Residential address is mentioned.

Pleaseindicate❒whichaddressshouldbeusedforcorrespondence/dispatchofInstitute’smagazine.Thisaddresswillalsodetermine the Branch to which you will be attached.

OfficeResidence

SECTION B : FOR APPLICANTS FOR “STUDENT” MEMBERSHIP ONLY:-

Name of DGS approved pre-sea TrainingInstitute

Please tick ❒ to select type of Pre-sea Training Course:-

4 YEAR CORECOURSE / 2 YEAR DMECOURSE / 1.5 YEAR GEECOURSE
1 YEAR GMECOURSE / ATS / INS SHIVAJI OREQUIVALENT

Any other, pleasespecify

Date of commencement ofcourseDate of completion ofcourse

SECTION C : CERTIFICATION

1. Degree orDiplomaYear Institute / INITIALSOFPROPOSERORSECONDER
2. Certificate of CompetencyheldDate examination passed: Certificate No.: Date of issue:

Head Office: 1012Maker Chamber-V, Nariman Point, Mumbai- 400 021.Tel.: +91-22-2283 4035, Fax: +91-22-2283-4035

SECTION D : EXPERIENCE AND PAST EMPLOYMENT

(1) Employment at sea since qualifying for current Certificate of Competency
Naval Officers to indicate the name and type of ship on which sea service performed. / INITIALSOFPROPOSERORSECONDER
Rank / From / To / Name of Shipping Company / Name of NavalShip
(2) Employmentashore
Designation / From / To / Name ofEmployer
(3) Membership of other Professional or Technical Societies
Institute / MembershipGrade / MembershipNo.

SECTION E : RECOMMENDATION

SECTION F : DOCUMENTS

Note : Please submit Xerox copies of following along with your application form –

  • Letter from the Head of Training Institute (only for “Student” membership)
  • Academic Certificates and letter from employer for Graduate Engineers without any sea experience
  • CertificateofCompetencyandC.D.C./ShipServiceRecordBookandLetterfromEmployerforEmploymentashoreincluding designation and nature of marine relatedduties
  • Certificate of Rank and Certificate of Service (For Navy and Coast Guard personnel)

Grade / Subscription / Processing Fees / Life Membership Fees / Transfer fees / Total fees is to paid / Membership Limited upto
upto Fellow grade / at the time of submission of application
Student Membership / Rs. 500/- / 100/- / 600/- / will be limited for a period of Six months after completion of their training
Student to Graduate Grade / Rs. 1000/- / 1000/- / Graduate member shall remain as Graduate Members for aperiod of 5 years . After this period the membership shall lapse, unless renewed
Direct Graduate Grade / Rs.1500/- / Rs.100/- / 1600/- / Graduate member shall remain as Graduate Members for aperiod of 5 years . After this period the membership shall lapse, unless renewed
Graduate Life Members / Rs. 100/- / Rs. 5400/- / Rs. 6400/- / 11900/-
Associate Grade / Rs. 100/- / Rs. 5400/- / Rs. 4800/- / 10300/-
Associate Member Grade / Rs. 100/- / Rs. 5400/- / Rs. 3200/- / 8700/-
Member Grade / Rs. 100/- / Rs. 5400/- / Rs. 1600/- / 7100/-

SECTION G : PAYMENT

Fees may be paid cash or by cheque / DD payable to The Institute of Marine Engineers (India)Demand Draft should be madepayable at Mumbai. Please write your name at the back of cheque / D.D.

  • Cheque / D.D. No. ______Dated: ______Drawn on: ______
  • For NEFT Payment Details: Name of the account: The Institute of Marine Engineers (India) Name of the Bank – IDBI Bank

Savings Bank account No. 244104000013165 IFSC Code – IBKL0000244

Iherebygivemyconsenttotransferanyamountspaidbymetowardsprocessingfee,entrancefees,transferfeesorLifemembershipfeestotheGeneral Corpus of theInstitute.

SignatureDatePlace ___

Head Office: 1012Maker Chamber-V, Nariman Point, Mumbai- 400 021.Tel.: +91-22-2283 4035, Fax: +91-22-2283-4035