FORM R.
B 3
REPUBLIC OF KENYA
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ENGINEERS BOARD OF KENYA
THE REGISTRAR
ENGINEERS BOARD OF KENYA
P. O. BOX 30324-00100
NAIROBI
RE: APPLICATION FOR REGISTRATION AS A PROFESSIONAL ENGINEER
Surname ………………………………………………………………………………..……...…
Other Names …………………………….………………………………..………………………
Title (Dr., Mr., Mrs., Miss) …………………………………………………………..…….….…
Birth Date …………………………………………………………………….…………………..
Nationality ………………………………….………………………………..……………………
Postal Address ………………………………………… Telephone ……………………..……...
Email Address …………………………………………………………………………………….
Academic Qualifications …………………………………………………………………..……..
Discipline …………………………………………..……………………………………….…....
Date of registration as a Graduate Engineer. ……………… Registration No. ……………..
Name of Employer and Address…………………………………………….……………….…...
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Revised Feb. 1998
NOTE: All information to be printed in English Language.
EDUCATION:
Diploma/Degree Month and
School or University Location From To
Received Year
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Note:- The application must be accompanied by two coloured Passport Size Photos, IEK
Membership, certified copies of the original Degree Certificate, Engineers Registration Board
Certificate, and a copy of the National ID/Card or Passport all duly certified by a Commissioner
of Oaths whose names and address are fully displayed on the Rubber Stamp .
SPECIAL QUALIFICATIONS:
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MEMBERSHIP OF ENGINEERING INSTITUTION:
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Revised Feb. 1998
EXPERIENCE:
I submit below a chronological history of my practical experience including the name and
address of each company and description of each position held. (A separate sheet may be used
if necessary). This should be certified by one of the referees named below.
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REFERENCE:
I append the names and addresses of three Registered Engineers, to whom reference may be
made regarding my experience and character.
1. …………………………………………………………………………………………
2. …………………………………………………………………………………………
3. …………………………………………………………………………………………
An applicant’s supervisor should be listed as one of the referees. Persons named as
referees MUST be Registered Engineers and with a current valid Annual Licence.
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APPLICATION FEE – KSH. 1,500. Must accompany the application and is non-refundable.
(Crossed Cheques or Postal Orders preferred).
1. I attach my application fee of Kshs. 1,500 payable to the Engineers Registration Board.
2. I hereby declare that the foregoing statements are true in every respect and that I have
read the Act and understood that, if registered, I shall be bound thereby and by any
amendments thereto so long as my name remains on the Register.
Signature of applicant …………………………………..
Date ………………………………………
FOR OFFICE USE ONLY
Deposit receipt No ……………………..……… Date of Registration …………………..…….
Registration Number …………………………… Candidate notification date …….………….
GPK (L)
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Revised Feb. 1998