ImeOnline Application For Election To Membership

The Institute of Marine Engineers (India)
IMEI House, Plot No. 94, Sector 19, Nerul, Navi Mumbai 400706
Tel. : +91 22 27701664, Fax : +91 22 27711663 Email : membership@imare.in

APPLICATION FOR ELECTION TO MEMBERSHIP

PLEASE FILL IN BLOCK LETTERS

Application For Election (Select a grade) :

Member Associate Member Associate Graduate

Please see the attached Eligibility Criteria for Election to various grades of membership.
The Institute decision of grade of membership will be final and binding.

Name (in full)

First name	Middle name	Surname

Please Click

Male Female Date OF Birth :

Address For Correspondence

State :

Pin Code :

Telephone :Office :

Res :

Fax :Office :

Res :

Email :Office :

Res :

Mobile Phone :

INDOSS NO

For official use

1. Degree or Diploma

Year

Institute

2. Pre Sea Training

Year

Institute

3. Apprenticeship or Practical Training

Year

Institute

4. M.O.T. Certificate held

Date of examination passed :

Certificate No. :

Date of issue :

5. Experience and Past Employment

(A) Employment at sea since qualifying for current MOT certificate

Rank	From	To	Name of Shipping Company

(B) Employment ashore

Designation	From	To	Name of Employer

Reference kindly give name of two members who know you personally
Members Name (in Block Letters) : Membership No. :

Members Name (in Block Letters) : Membership No. :

Note : In case you do not have any reference please submit xerox copies of following along with your application form -

Academics Certificates as specified in the attached criteria, as applicable
M.O.T. Certificate
C.D.C. / Ship Service Record Book or letter from Employer (in case of experience other than sea service)
Certificate or Rank and Certificate of Service (For Navy and Coast Guard personnel)

Fees may be paid by cash, by cheque or online(Click For Online Payment). Cheques to be made payable to,

The Institiute Of Marine Engineers (India). Please write your name and membership number (if any), at the
back of cheque. For amount of fees payable kindly refer to eligibility criteria document.

I enclose herewith payment of amounts as detailed below by Cash / Cheque No.

Dated :

Drawn on :

Entrance fee Rs. : For Grade :

Subscription fee Rs. : For Grade :

Life Membership fee (if opted for) Rs. :

Total Rs. :

I confirm that I have read the eligibility criteria for various grade of membership. Click For Eligibility Criteria
I also confirm that the information given above is true.
I hereby give my consent to transfer any amounts paid by me towards entrance fees, transfer fees or Life Membership fees to the General Corpus of the institute.

Kindly tick the above Boxes to confirm. If all the boxes are not tick your application will not be accepted.

Name Date Place

Regd. Office : Institute of Marine Engineers (India), 1012, Maker Chambers-V, Nariman Point, Mumbai - 400021

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