IEM Membership Application Form

APPLICATION FOR ADMISSION AS GRADUATE-NEW MEMBER

Personal Particular
Full Name RUBHENDRAN KRISHNAN
Permanent Address 3, PINTAS SIAKAP 1, SEBERANG JAYA
State PENANG
Other State -
Postcode 13700
Country MALAYSIA
Postal Address 3, PINTAS SIAKAP 1, SEBERANG JAYA
State PENANG
Other State -
Postcode 13700
Country MALAYSIA
Gender Male
Race Indian
Nationality Malaysian
Place of Birth PENANG
D.O.B -
I.C/Passport No 870219075269
Home No -
Mobile No 0104694565
Office No -
Email rubhendran@gmail.com

Current Position
Name of firm/Employer LOTTE ENGINEERING & CONSTRUCTION CO. LTD.
Address PLO 312, JALAN TEMBAGA 4, PASIR GUDANG INDUSTRIAL ESTATE
State JOHOR
Other State -
Postcode 81700
Country MALAYSIA
Position MECHANICAL ENGINEER
Date of Appointment -

Discipline
Discipline MECHANICAL
Other Discipline -
 BEM Graduate Eng. 90126A
Registration No

Proposer
Proposer # MEMBERSHIP NO: 05009 SIGNATURE:
FULL NAME: QUEK SWEE KIM
GRADE: MEMBER

General Education
Name of Examination passed Date Awarded Certificate & Transcript
University/IHL
DONGYANG MIRAE Diploma 20-Feb-2009 uploaded
UNIVERSITY

Engineering Education
Name of Engineering Date Awarded Type of Study Certificate &
University/IHL Degree/Diploma Transcript
Obtained
KOREA BSc 25-Feb-2011 Full Time (3 Year) uploaded
UNIVERSITY

I ,RUBHENDRAN KRISHNAN, the undersigned, do hereby promise that in the event of my admission/transfer shall governed by the Constitution,
By-Laws and Regulations of the Institution for the time being in force, and that I will accept as final and binding the decisions of the Council on all
matters dealt with by them in accordance with the provisions of the said Constitution, By-Laws and Regulations. I further undertake that I will
promote the objectives of the Institution as far as may be in my power, provided that whatever I shall signify in writing to the Secretary that I am
desirous of withdrawing from the Institution. I shall, after payment of any arrears which may be due from me at the period, be free from this
obligation. I accept responsibility for the accuracy of the particulars contained in this online application form and agree that if I am admitted the
validity of my admission shall depend upon the accuracy of such particulars as required by the By-Laws.

I, RUBHENDRAN KRISHNAN hereby acknowledge that in the event my qualification are found to be non-compliant to the Admission criteria of the
Institution due to changes in policies or oversight at the time of admission the Institution reserves the right to withdraw my membership.

Name : RUBHENDRAN KRISHNAN

IC No: 870219075269
Date: 28-Jun-2017