Form Page 2

Having read the By-laws and being willing to conform there-to, I submit that I am eligible on the grounds that I have passed the qualifying examination and have the requisite experience. My qualifications are set forth in my answers to the following questions viz;

1) Are you or have you ever been a member of the Institution or applied for membership? If so, give particulars

2) Give particulars of any honours or decorations which you may have.

3) Are you a member of any other professional institution? If so, specify

4) Indicate the type of work undertaken by the firm / company / department you work for

5)Specify the qualification(s) you have that qualify you to apply for the class of membership you are applying for i.e
certificate, diploma, degree e.t.c

APPLICANT’S DECLARATION
I, the undersigned do hereby promise that, in the event of my election I will abide by the constitution and By-Laws of the said Institution, as they now exist ,or as they may hereafter be altered, amended or enlarged, and I promise to promote the objects of the said Institution as far as shall be in my power, and to uphold the principles and Code of the profession as often as I conveniently can; provided that whenever I shall signify in writing to the Chief Executive Officer that I am desirous of withdrawing my name there from, I shall (after the payment of any arrears which may be due by me at that period and subject to the said By-Laws ) be free from this obligation and will return my membership certificate / letter forthwith.

I also engage that I will not at any time after ceasing to be a member of the Institution use or permit to be used in conjunction with my name, or the name of any undertaking with which I am at any time associated, any designation or expression whatever denoting or suggesting member of or connection with the Institution, referring in any way to my past membership of the Institution.

Witness my hand this