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APPLICATION FORM FOR LIFE MEMBERSHIP

(Note : Please read instructions overleaf carefully before filling up the form)

To,
The President,

Practising Engineers Architects and Town Planners Association (India)
Unit No. A-103, 1st Floor, New Udyog Mandir No. 2,
Behind Johnson & Johnson, 7-C, Mogul Lane, Mahim (W), Mumbai - 400 016.

I the undersigned, would like to get enrolled as Life Member of PEATA (I). I promise, if enrolled, will abide by and observe the provisions of the constitution in force and that I will promote the objects of the Association as far as may be in my power. I enclose herewith necessary documents listed below along with a cash/cheque for Rs. /- in favour of PEATA (I)
towards following :-

PEATA Membership No.
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First Name
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Last Name
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Father/Husband's Name
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Name of Establishment
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Classification
Builder/DeveloperContractorManufacturerReal Estate ConsultantInterior DecoratorIndividual
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Designation
ProprietorPartnerAssociateDirector
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Office address
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Residential address
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Phone No
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Whatsapp No.
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Email Address
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Password
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    Strength: Very Weak
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    Date Of Birth
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    Age
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    Blood Group
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    PAN No
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    Service Tax Code (PAN BASED)
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    Technical Qualifications
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    Number of years in Construction Industry
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    Special field of Interest/Expertise
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    Membership of any other Professional Societies / Association / Institution with Registration Nos
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    Registration Details :
    Surveyor / Structural Engineer's License, issued by Municipal Corporation of Gr. Mumbai OR any other please specify
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    License No.
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    Date
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    Surveyor / Structural Engineer's License
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    Registration Certificate issued by, Council of Architecture - New Delhi.
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    Registration No.
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    Date
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    Registration Certificate
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    Note : Attach Attested Xerox Copy of up to date valid, Surveyor's / Structural Engineer's License, issued by M.C.G.M. or any other / or Registration Certificate issued by the Council of Architecture - New Delhi.
    Number of years in Practice as Licenced Surveyor/Architect/Structural Engineer/Town Planner/Regd. Valuer/Landscape Architect/Interior Designer or any other related profession
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    Years
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    Special field of Interest/Expertise
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    Membership of any other Professional Societies / Association / Institution with Registration Nos.
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