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The Institution of Engineers ( India)

8, Gokhale Road, Kolkata 700 020


EXAMINATION APPLICATION FORM FOR
SUMMER / WINTER 2 0 0 0

NAME (in capital letters)

ADDRESS (in capital letters)

PIN

Mobile No. Telephone No.

E-mail :

Engineering
MEMBERSHIP GRADE Scheme Code Branch Code
(T/ST/A/AM/M/F) MEMBERSHIP NUMBER (AN=2, AD=3, B=4) (CH=04, CV=05, .........)

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

2. I wish to appear from Examination Centre Code No.

* Write Code No. of subjects in serial


order in which desires to appear

* For example, C V 4 1 3 , refer Rules : Vol. 1 effective from Summer 2005 Examination.

FOR SECTION B CANDIDATES ONLY

(a) Passed Section A / Section A (D) / Section B completely in Summer / Winter


with Roll No.

(b) Secured exemption from Section A / Sections A and B in ___________________ (term/year)

I shall abide by the Rules of the Institution Examinations as printed in Rules (Vol. I) effective from Summer 2005 Examination.

Full Signature of Candidate with Date

Enclo: Demand draft of Rs. ______________ no. ________________ dated ____/____/______/


drawn on __________________________________________________ (Bank) in favour of
‘The Institution of Engineers (India)’, payable at Kolkata.

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