ENGINEERS

INSTITUTE OF INDIA
Indias Best Institute for IES, GATE & PSUs

A Team of IES & GATE Toppers A Team of IES & GATE Toppers

REGISTRATION CUM ADMISSION FORM Ref: E.I.I./2013/ADM/01

Registration No. (For Official use)

Paste recent Photograph

Name of the Condidate : Fathers Name : Date of Birth dd/mm/yy D D M M Y Y Y Y

Complete Mailing Address:

Pin No.

PHONE NO.

Email ID: Branch ( B.Tech ) Course ( ) : Regular Crash Course Weekend Test-Series Summer Batch Interview Guidance Postal-Course

Programme ( ) :

GATE J.T.O.

GATE-PSUs
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Combined IES-GATE-PSU Other

Joining Date & Month (Applicable for classroom course only ): Mode of Payment ( ) : Cash deposit at Bank Cheque / Demand Draft Net Banking /Online Transfer

Name of Bank : ................................................................................... Bank Branch: ..................................................................... Date of Payment: D D M M Y Y Y Paid Amount : In case of Net Banking /Online Transfer provide us your Reference ID or Transfer receipt No. Page No. 1

Cheque / Demand Draft No.

Payment & Application Details :

1. Cheque / Demand Draft should be made in favour of Engineers Institute of India payable at New Delhi For Online Bank Transfer or Bank Deposit ENGINEERS INSTITUTE OF INDIA, A/C No. 3234-8363-825 Bank : State Bank of India Branch : IIT New Delhi IFSC Code: SBIN-0001077 MICR Code: 11000-2156 For classroom programme Registration fee is Rs. 3,000.00 (Inclusive of total fee) For Postal / Correspondence & Test-Series NO REGISTRATION FEE is required, candidate need to pay only course fee.

2. Incase of Bank Deposite / Online Transfer, send your deposite receipt / transfer receipt copy at eiidelhi@gmail.com 3. Attach following documents along with your completely filled Registration form: (a) Two passport size photograph (b) One copy of Identify proof (Driving Licence, Voter ID, Passport, College ID) (c) Cheque / Demand draft / Payment proof. NOTE: (Must write your Name, Course and Mailing address with Mobile Number at the back side of the Cheque / Demand draft) Email Scan copy of completely filled Registration form along with above documents at eiidelhi@gmail.com OR Send your completely filled Registration form along with above documents through Courier or Speed Post at Head-Office address :

To, Engineers Institute of India (E.I.I.) 28B/7, Jia-Sarai, Near IIT Main Gate, Hauz-Khas, New Delhi PIN : 110016 Helpline: 011-26514888 www.engineersinstitute.com

Signature of the Candidate with date

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