THE INSTITUTION OF ENGINEERS (INDIA)

8 Gokhale Road, Calcutta 700 020

EXAMINATION APPLICATION FORM FOR SUMMER/WINTER 20...............
Name & Address of the Candidate

Membership Grade & Number

Grade

Number

*Examination Code
*Engineering Branch Code

Incomplete or illegible application shall be rejected without reference to the candidate.

I shall abide by the Rules of the Institution Examinations as given in Vol. I of Rules & Syllabi.

1.

Appeared previously in Summer / Winter 19 ........................ with Roll No.

*Write Code No. of Subjects

in which desires to appear

2.

Choice of Centre
*(in Code Nos. only)

FIRST
CHOICE

SECOND
CHOICE

THIRD
CHOICE

FOR SECTION B ONLY

(a)

Passed Section A/A(D) / B completely in Summer / Winter 19 ............... with Roll No.

(b) Secured exemption from Section A / Sections A and B in the year .................................
*See Appendices VI and VIII for Code Numbers.

Signature of Candidate in Full & Date

Enclosed Bank Draft No. .................................... dated ............................

for Rs. on .................................................................................. (Bank)
in favour of The Institution of Engineers (India), payable at Calcutta.
___________________________________________________________________
RECEIPT OF EXAMINATION FORM WITH FEES
(if deposited at Headquarters Cash Counter only)

Received the Examination Form with a demand draft of Rs. ............................. for Summer / Winter 19 ............ Examination
from .................................................................................... (T/ST/A/AM/M ...........................................).

Cashiers Stamp & Signature