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INSTITUTE OF CHARTERED SHIPBROKERS shield2 Election as a Member

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					                                      INSTITUTE OF CHARTERED SHIPBROKERS

                                            Election as a Member via Dissertaion
                               ICS Office: 85 Gracechurch Street,
                               London,
                               EC3V 0AA
                               Telephone: 020 7623 1111
                               Fax: 020 7623 8118
                               Email: admin@ics.org.uk

TO THE CONTROLLING COUNCIL
I wish to apply for election as a Member of the Institute of Chartered Shipbrokers via the submission of a dissertation. I
undertake to observe the Bye-Laws of the Institute.

Title:                                      First Name:                          Last Name:

Job Title:                                         Company:


Business Address:


                                                                         Postcode:


Home Address:


                                                                         Postcode:


Email 1:                                           Email2:                                Telephone:

    Please indicate the address you would like us to send books and correspondence to -      Home:            Business:

Age:                                        Date of birth DD/MM/YYY:                      Nationality:



                           PLEASE READ THE RULES AND GUIDELINES FOR DISSERTATION WRITERS




   Signed                                                                            Date:

    This form is not valid unless signed.

    THIS FORM MUST BE SENT TO YOUR LOCAL BRANCH SECRETARY. IF YOU HAVE NO LOCAL BRANCH, SEND TH
    FORM DIRECT TO admin@ics.org.uk. PLEASE DO NOT SEND MONEY WIT THIS FORM (N.B. £150 is payable upon
    presentation of your completed dissertation




    Page 1 of 3
Career Details
Please give details, in reverse chronological order, of all companies for whom you have worked since leaving school
(include any service with the Armed Forces or Merchant Navy). State particularly the positions held and the work
experience gained in each case in order that the Vetting Committees may assess your suitability for dissertation entry.




 THIS FORM MUST BE SENT TO YOUR LOCAL BRANCH SECRETARY. IF YOU HAVE NO LOCAL BRANCH SEND THE
 FORM IN BY EMAIL TO admin@ics.org.uk. PLEASE DO NOT SEND MONEY WITH THIS FORM. (£150 is payable on
 the presentation of your completed dissertation)

 You will need authorisation to proceed with your dissertation. Upon completion of your        dissertation please
 send three bound copies to your branch and one electronic copy to admin@ics.org.uk.




 Page 2 of 3
                                                PROPOSED DISSERTATION

For identification purposes state here the title of (or a one sentence description of) your proposed dissertation:




Then on a separate sheet give details of your intended topic in accordance with the information in “Guidelines for
Dissertation Writers”. If you need advice with this please contact admin@ics.org.uk who will put you in touch with
someone who can assist you.

All applicants for election to Membership must obtain the signatures of two Fellows of the Institute in support of their
application.



I confirm that this candidate has been known to me for ______ years and is a fit and proper person to become a
Member of the Institute.

Proposed by _____________________________________________ FICS ___________________________________
            Signed                                             Please repeat name in block letters



I confirm that this candidate has been known to me for ______ years and is a fit and proper person to become a
Member of the Institute.

Seconded by _____________________________________________ FICS ___________________________________
            Signed                                             Please repeat name in block letters

(NB If the applicant has difficulty in completing the above, please contact the Institute of Chartered Shipbrokers)


                                                    FOR BRANCH USE ONLY
   Branch Vetting Committee Stamp.




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