SCEM Application Form - Institution of Engineers Singapore

SINGAPORE CERTIFIED ENERGY
MANAGER (SCEM) REGISTRY
SINGAPORE
To be submitted to:
Secretary,
SCEM Registry
The Institution of Engineers, Singapore
70 Bukit Tinggi Road
Singapore 289758
APPLICATION FOR REGISTRATION
(Cheque payable to ‘IES’)
1. REGISTRATION LEVEL
Associate
Professional
2. PERSONAL DETAILS
Full Name
Title
Prof
Dr
Gender
M
F
Mr
Mrs
Ms
Others (Please specify)
Date of Birth : ______________________
NRIC/Passport No
Job Designation
3. CONTACT DETAILS
Name of Employer
Business Address
Phone
Mobile
Fax
Email
Home Address
Preferred Mailing
address
£ Business Address
£ Home Address
4. ACADEMIC / PROFESSIONAL QUALIFICATIONS
University / College / Institute
Title(s) of Qualification(s) awarded
Branch(es) of Engineering
Month / Year Awarded
Key Qualified Persons (KQPs) registered no. _________________________________ under the Energy
Services Company (ESCO) Accreditation Scheme.
(Note: With effect from 22 July 2010, KQP is no longer exempted from SCEM Training )
20-Jan-15
5. SUMMARY OF POST-GRADUATE PROFESSIONAL EXPERIENCE
Time
(Yrs & Mths)
Date
From
To
Title and cost of project, title of position held,
degree of responsibility in each engagement,
indicate supervising Engineer where applicable
In Design or
Research (A)
Yrs
Mths
Supervision or
Investigation
Works (B)
Yrs
Mths
Total Time
(Yrs & Mths)
(A + B)
Name and Address of Employer
Yrs
Mths
Note: Applicant may submit supplementary sheets in the above format, if necessary
20-Jan-15
6. PARTICULARS OF 2 OR MORE REFEREES
Name of Referee
Relationship
Address
Contact No.
E-mail Address
7. DECLARATION BY APPLICANT
By signing below, I: ________________________________________
-
-
Declare that all statements on this application form are true and accurate to the best of my knowledge.
Undertake to inform the SCEM Monitoring Committee of any pertinent details which may affect my eligibility for
SCEM Registration.
Give my consent to the publication of my professional details, in any form, in association with my registration as a
SCEM.
Attach copy of my degree certificate and transcripts
Attach results of SCEM Training with pass on 4 core modules and 2 elective modules within 36 months
Attach herewith my cheque from Bank _______________________ cheque no.______________________ for the
amount of $_______ dated ___________________; crossed and payable to ‘Institution of Engineers, Singapore’ or
‘IES’ being payment of total fees of *$214.00 for 1 year.
Name to be printed on Official Receipt: _____________________________________________.
The total fees comprises of:
- Application Fees (One Time, Non-Refundable ) of *$ 107.00 - only for new application and
- Annual Registration Fees of *$107.00 (Annual)
*Incl.7%GST
‘PERSONAL DATA PROTECTION ACT
I hereby agree and consent that IES (“THE INSTITUTION OF ENGINEERS, SINGAPORE ”) may collect, use, disclose and
process my personal information set out in my application form, or otherwise provided by me or possessed by IES , for one
or more of the purposes as stated in IES Personal Data Protection Terms and Conditions www.ies.org.sg/pdpa.’
Signature…………………………………………….
Date:
/
/
(dd/mm/yyyy)
20-Jan-15

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