t h e h o n g k o n g i n s t i t u t i o n o f e n g i n e e r s- h k i e（t h e h o n g k o n g i n s t i t u t i o n o f e n g n e e r s - h k我e）（31页）.docVIP

PLEASE READ CAREFULLY AND COMPLETE IN DETAIL FORM 1/D APPLICATION FOR ADMISSION IN AN ADDITIONAL DISCIPLINE BY PROFESSIONAL ASSESSMENT For use by HKIE Corporate Members, where application is not supported by a relevant, recognised professional qualification. (One Form to be completed for each Discipline) Please tick as appropriate: Formal Training Route General Experience Route Mature Route Others (Please specify): Applicant to complete Sections A, B, C and D. Supporters to complete Section E, and to initial those parts of Section D which are appropriate. Complete in block letters or type Section A ( Personal details (Please indicate your name as shown on the H.K.I.D. Card or other identification documents) Surname Ir/Prof/Dr Female/Male Other Names ID Card No Chinese Name (if applicable) Address for Communication Tel No. Mobile Residential Address Tel No. E-mail Company Name Tel No. Position Fax No. Date of Birth Age Place of Birth Section B ( Present membership number Present Discipline/s Discipline applied for e.g. Aircraft, Biomedical, Building, Building Services, Chemical, Civil, Control, Automation Instrumentation, Electrical, Electronics, Environmental, Energy, Fire, Gas, Geotechnical, Information, Logistics Transportation, Manufacturing Industrial, Marine Naval Architecture, Materials, Mechanical or Structural Section C ( I declare that I am currently competent to practise in the _______________________ Discipline, for which I am applying, and that the statements on this form are correct. Signature of applicant Date 6/2015 This form needs to be completed and returned together with the Professional Assessment Fee required. (Details please refer to fee list) PRIVATE AND CONFIDENTIAL Section D ( From Mth/Yr To Mth/Yr 1. Academic qualifications (Photoco