THE SRI LANKA BRACH OF THE INSTITUTION OF FIREENGINEERS U.

Fire service department, T.B Jaya Mawatha, Colombo 10

Tel: 0112 572289 E-mail: [email protected] Web: www.ifesl.org

APPLICATION FOR MEMBERSHIP

1. Name in Full ........................................................................................................................

2. Name with Initial ........................................................................................................................

3. Date of Birth (DD/MM/YY) ..............................................................................................................

4. NIC number ………………………………………. Date of issue ……………………………..

5. HomeAddress......................................................................................................................................

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Tel: ................................................................................ Mobile: ..............................................................

E mail ………………………………………………………………………………………………………………………….

6. Business Address (including Company Name):

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Designation …………………………………………………………………………………………………………………

Tel: .............................................................................. E-mail: .................................................................

Address to which correspondence is to be sent – please tick one.

Business Home

6. GRADE OF MEMBERSHIP for which application is made – please tick appropriate

Student Associate

Technician Member

Graduate Fellow
7. Routes to membership- Is this application based on (tick relevant box or boxes):

Your IFE examination

Other qualifications; (Individual Case Procedure)

8. IFE Examination Please give details of IFE examinations held

Paper Examination Date Passed

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2…………………………… …………………………………. ……………………………

3…………………………… …………………………………. ……………………………..

4…………………………… …………………………………. ……………………………..

9. Academic and Other professional qualification

Please give details of such qualifications you hold - Remember to enclose validated
photocopies of all certificates

Qualification University/Institution Date of Award Contact

details

1…………………………… ………………………………… …………………… ……………………….

2…………………………… …………………………………. ……………………. ………………………..

3…………………………… …………………………………. ……………………. ………………………..

10. Professional, Engineering and/or Scientific body membership

If you hold any such memberships complete the details below and enclose validated
copies of all certificates

Name of body Class of Membership Designatory letter Contact details

1……………………………… …………………………….. ………………………………. ………………......

2……………………………… …………………………….. ………………………………. ………………......

11. Fire related training

Year Course Duration Training Institute

1.…………………… …………………………….. ……………………… ………………................

2…………………… …………………………….. ……………………… ………………................

12. Experience or past employment

Name of the Employer Designation years of serviced Contact Numbers

1.………………………….. …………………………….. ……………………… ………………................

2…………………………... …………………………….. ……………………… ………………................

3.………………………….. ……………………………. ……………………… ………………................

13 Present employments

Name of Employer

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Job Title: ……………………………………………… Date of Appointment …………………………………

Details of work responsibilities, etc – Please state below full details of your work and
responsibilities, particularly those relating to fire engineering.

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Certified by head of current employer

Name ………………………………………………

Designation ……………………………………………... …………………………..

Signature ……………………………………………… Date & Stamp

14 Declaration

I do hereby to declare that above mention facts are true and correct according the
best of my knowledge.

Date …………………………… ………………………………………………………..

Signature of the applicant

15 Referees.

Please give contact detail two non-related referees

1. Name ………………………………………………

……………………………………………...

Contact number ………………………………………………

2. Name ………………………………………………

……………………………………………...

Contact number ………………………………………………

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For official use only

A. Date received ;……………………………………………………………………..

B. Date of made the payment ;……………………………………………………………………..

C. Amount Paid ;……………………………………………………………………..
D. Submission date to the
Committee for approval ;……………………………………………………………………..

Declaration of membership committee,

We checked the content of the application and we do here by to declare that above
mention facts are true and correct according to the best of our knowledge.

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Name of the Head of the membership committee Signature & Date

Sate of approval Yes No Membership Number :………………………………