FORM OF APPLICATION FOR ELECTION AS A MEMBER


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INSTITUTE OF CHARTERED SHIPBROKERS

85 Gracechurch Street, London EC3V 0AA, Telephone : +44(0)20 7623 1111, Fax: +44(0)20 7623 8118.
Email: membership@ics.org.uk

This form must be sent to your local branch secretary. If you have no local branch, send the Form to the Head Office in London - please do not send any money with this form.

TO THE CONTROLLING COUNCIL

I wish to apply for election as a Member of the Institute of Chartered Shipbrokers, having completed and passed the Professional Qualifying Examinations in the following year:

(If you intend to seek election via dissertation, do NOT use this form )

(Applications for election will be placed before the Council for consideration at the meeting immediately closest to the applicant's completion of either three or four years service )

PERSONAL DETAILS

Title	:
Surname	:
Given Name	:
Date Of Birth	:
Age	:
Nationality	:
Home Address	:
Address 1 [Optional]	:
Address 2 [Optional]	:
City	:
Country	:
Post Code	:
Telephone No	:
E-mail	:

BUSINESS/EMPLOYER DETAILS


Company Name	:
Address 1	:
Address 2 [Optional]	:
City	:
Country	:
Post Code	:
Telephone No	:
Fax [Optional]	:
E-mail	:

Please direct all my communications to this address

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WORK EXPERIENCE

The Bye-Laws require an aggregate of no less than four years services in employment having a bona fide connection with shipbroking, which may include service at sea. If your service has been under a Fellow of the Institute, the requirement may be reduced to three years and if you are claiming eligibility under the three-year rule you should state the name(s) of the Fellow(s) concerned. Time served at sea should be shown with the dates and ranks achieved.

Employer's Name	Designation	Date of Joining	Date of Leaving	Job Description


ELIGIBILITY UNDER 3 YEAR RULE	Yes

Name of Fellow	Company	Date of Joining	Date of Leaving

Last Updated On: February 14 2006