IET Revision 3 App. Form 3

Form I.E.T 2 Revision 3 Serial No.
------------------------
INSTITUTION OF ENGINEERING TECHNOLOGISTS AND TECHNICIANS (IET-K)
APPLICATION FOR MEMBERSHIP
I wish to apply for registration as a member of IET AFFIX

PASSPORT
I. Personal information PHOTOGRAPH
__________________________________________________________________
(Block Letters) Surname First Middle Name Other Names (in full)
Employer/Company Name: ______________________________________________
Date of Birth: ________________________________________

Day/Month/Year
Citizenship Kenyan Non-Kenyan
Postal Address: _______________________________________________________
Tel: __________________________________________
E-mail address: _________________________________
Town: _______________________________________________________________
Home Address________________________________________________________
Please send my mails to (Preferred Address) ____________________________________
________________________________________________________________________
II. Educational Background (Attach certified photocopies of your credentials)
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email:[email protected]/[email protected]
S/NO College/Institutions Attended From-------To Qualification Obtained with Date &
Discipline
III. Employment History/Work Experience
Employer Post Held Job Duration

Description/Duties
Field of Study: _________________________________________________________
Area of Specialization: ________________________________________________________________________
IV. PROJECTS
Briefly describe the projects undertaken in the last three years and your specific role in it:
S.NO Date and Year Project Name Cost Role
If necessary, attach more papers:_____________________________________________

NB: Student applicants to describe any relevant undertaken/continuing class project
V. Sponsors
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Your sponsors must be familiar with the significant time element, of your experience and preferably all your sponsors,
should be professional Engineers and /or Engineering Technologists. At least one of your sponsors must be an
ACTIVE AND FINANCIALLY up to date member of IET.
Name Professional Status M/No + Tel. Signature

Body
VI. Declaration by Candidate
1. I declare that all the above statements are complete and correct to the best of my knowledge and belief. I
agree to give additional information if the Council so requires. I understand that a false statement or
misrepresentation may disqualify me for registration and hence blacklisting.
2. I grant permission to IET to obtain such additional information, as they may deem appropriate from such
additional sources as they may deem necessary for the progression of my application.
3. I will conform to the constitution, the bye-laws and the code of Ethics, if granted membership.
Signature______________________________Date_________________________
NOTE:
Please forward along with your Form the following:-
1. Photocopy of I.D.
2. A detailed Curriculum Vitae.
3. Copies of your Academic and Professional Certificates.
4. Two Passport Size Photographs
5. Bank pay-in Receipt.
6. For Corporate Membership, you are required to submit a bound copy of technical write-up on your post-
graduation practical experience containing details of a chosen topic of study containing not more than 2000
words.
All payments shall be made under the account name:

Institution of Engineering Technologists and Technicians
Application fee:
Students: Kes: 500/=
Non-students: Kes.1,000.00
Payment details:
i. Equity Bank Ltd, Harambee Branch - Harambee Avenue
Account Number: 0240298461590,
or Mpesa paybill 247247.
ii. Kenya Commercial Bank (KCB), Haile Selassie Branch

Account Number: 1239915969,
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or Mpesa paybill 522522
iii. IET Mpesa Paybill: 4037659

A/C No.: Name / Id Number
For Official Use Only

Recommendation: _________________ Sign (Membership Sec.) ___________________________________
Interview_______________________________________________Date___________
Amount to be paid___________________________________________
Project Submitted Yes No
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IET Revision 3 App. Form 3

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Form I.E.T 2 Revision 3 Serial No.

INSTITUTION OF ENGINEERING TECHNOLOGISTS AND TECHNICIANS (IET-K)

APPLICATION FOR MEMBERSHIP

I wish to apply for registration as a member of IET AFFIX

Employer/Company Name: ______________________________________________

Date of Birth: ________________________________________

Citizenship Kenyan Non-Kenyan

Postal Address: _______________________________________________________

E-mail address: _________________________________

Please send my mails to (Preferred Address) ____________________________________

II. Educational Background (Attach certified photocopies of your credentials)

III. Employment History/Work Experience

Employer Post Held Job Duration

Field of Study: _________________________________________________________

Area of Specialization: ________________________________________________________________________

If necessary, attach more papers:_____________________________________________

Name Professional Status M/No + Tel. Signature

VI. Declaration by Candidate

All payments shall be made under the account name:

ii. Kenya Commercial Bank (KCB), Haile Selassie Branch

iii. IET Mpesa Paybill: 4037659

For Official Use Only

Project Submitted Yes No

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