ERC/AF/02

M a l a w i E n g i n e e r iGOVERNMENT
n g I n s t i t u t iOF
o nMALAWI
PO BOX 1193, BLANTYRE
Phone: 01 912 458 MALAŴI ENGINEERING INSTITUTION
Tel/Fax: 01 871 615 (Malawi Engineering Institution Act, 2019)
Email: [email protected]

ENGINEERING REGISTRATION COUNCIL Sunday, May 9, 2021

Eng. Dr. Fatsani KUMAMBALA
MEMBERSHIP APPLICATION FORM – REGISTRATION AS A FELLOW
C/O LUANAR
To: The Registrar
LILONGWE
FOR OFFICIAL USE ONLY
Engineering Registration Council
P. O. Box 30228, Capital Application No: …………………………..……….......................................
City Engineering Institution’s
Title: The Malawi Engineering Registration Council (ERC)
Lilongwe 3 Date Received: .………………………………………………………………………...
Subject: Appointment to represent “a lecturer in engineering or an allied discipline from an
Email: [email protected] Application
institution of higher learning.) - Section 19 fee
(2) Receipt
(ix) ofNo:
MEI……………………..……...……………….………
act 2019
Website: mei.org.mw
Dear Sir, Remarks: ……………………………………………………………….……………….
Telephone: +265 789 114
On behalf of the Malawi Engineering Institution,……………………………………………………………………………………….…………
and on my own behalf, I wish to communicate

1. yourofappointment
Full names the applicant:,by
Pr.the MEI Board, into the Engineering Registration Council (ERC) in
Eng/Prof./Dr.
accordance with Section 19. —(1) of the MEI Act 2019. The ERC is responsible for the registration
(a) Surname
and regulation of qualifications of the classes of membership of the Institution. You will represent
(b) First Names
a lecturer in engineering or an allied discipline from an institution of higher learning sector in accordance

with Section 19 (2) (ix) of MEI act 2019

2. (a) Date and Place of Birth

(b) Nationality
Therefore, In accordance with Section 20.—(1) of the MEI Act 2019, you shall hold office for a
*Attach
period of three a national
years and shallidentification document
be eligible for re-appointment for one further term. For the purpose
3. Sex of this clause, please note that commencement date of your duties is 15th May 2019. Accordingly,
your will be expected to formally respond to the MEI Board on your availability to serve on the
th
4. (a) ERC to by Address
Permanent 15 May 2021 by completing and returning the attached form.

(b) Present Employer and address

For: Malawi Engineering Institution

Eng. Alfonso CHIKUNI

Present Position PRESIDENT

(c) Telephone Number:

Att’d
(d) E-mail Address:

5. MEI Class of Membership and Registration No.: …...……………………………………………….....

*Attach copy of authenticated certificate

6. Evidence of annual subscription payment: …...…………………………………..………………….....

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7. Membership with other Engineering professional bodies
Name of Engineering Country Class of Membership or Registration Date
Institutional/Association/Board/Council registration Number

* Attach copies of authenticated certificates

8. Membership with other professional bodies Other than Engineering professional bodies
Name of Engineering Country Class of Membership or Registration Date
Institutional/Association/Board/Council registration Number

* Attach copies of authenticated certificates

9. Experience after registration as a Professional Engineer

From To Name of employer Work on which the applicant was engaged, and
(month & (month position held
year) & year)

Position held:
Work executed:

Position held:
Work executed:

Position held:
Work executed:

Position held:
Work executed:

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10. Contribution to Engineering practice and the profession
10.1 Engineering practitioners personally trained up to registration as a professional Engineer

Engineering assignments of significance personally involved in, including research and

10.2
publications, indicating specific functions performed

10.3 Participation in the activities and affairs of the Institution and the Engineering profession

11. Any other relevant information

12. Statutory declaration by applicant:

(Name in full, in block letters and underline Surname)

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of

(Permanent Address)
hereby apply for registration on the Register of Fellows and submit herewith:

(a) the prescribed application fee of K and

(b) the following certified copies of academic and professional registration certificate(s) in
support of my application:

I do solemnly and sincerely declare as follows:

1. THAT I am the holder of the following degrees, diplomas or certificates granted to me after
examination by a university, college, professional institution, or other examining authority, and
that the courses of study in the professional subjects with respect to which the degrees, diplomas
or certificates which I hold covered the following periods:

University, college, or other Period Degree, Diploma Examining

institution From To or Certificate Authority
1.

2.

3.

4.

2. THAT as far as my professional qualifications are concerned, I am entitled to practice my

profession in Malaŵi and in the country in which my professional qualifications were granted.

3. THAT―
(a) I have never been suspended or expelled from practicing my profession in Malaŵi or any
other country on the grounds of professional misconduct; and

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(b) my name has never been removed from any register of engineers or members of my
profession kept in accordance with the Laws of Malaŵi or of any country in which I have
practiced my profession; and
(c) no inquiry is pending which may result in an action being taken which is referred to in
subparagraph (a) or (b).

4. THAT I hereby solemnly and sincerely declare that the information I have given above is true in
every respect to the best of my knowledge and belief.

5. THAT I have read the Act and the regulations made under the Act and understand that, if
registered, I shall be bound thereby and by any amendments thereto, for as long as my name
shall remain on the register.

THAT I undertake, if registered, to abide and uphold the aims and objectives of the Malaŵi
Engineering Institution.

13. Referees

1. Name of Referee:

Address:

Cell Phone No: Email:

Class of Membership: Registration No.:

Year of Registration: Signature:

2. Name of Referee:

Address:

Cell Phone No: Email:

Class of Membership: Registration No.:

Year of Registration: Signature:

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3. Name of Referee:

Address:

Cell Phone No: Email:

Class of Membership: Registration No.:

Year of Registration: Signature:

AND I make this solemn declaration conscientiously believing the same to be true.

Signature of applicant
DECLARED at this day of 20

Before me:

Signature of Attesting Authority

Capacity of Attesting Authority (e.g. Notary Public, Commissioner for Oaths, etc.)

NOTE: This declaration, if made―

(a) in Malaŵi, must be made under the Oaths, Affirmations and Declarations Act (Cap. 4:07);
(b) in any other country of the Commonwealth, must be made before a Notary Public, Commissioner for
Oaths or other person having authority in that country under any law for the time being in force to
take or receive an oath, an affirmation or a declaration; and
(c) in any other place, must be made before a Malaŵian consul or vice-consul or before any person
having authority under any Act of Parliament of the Laws of Malaŵi for the time being in force to
take or receive an oath, affirmation or a declaration.