Last Date for submission of Re-valuation form: 25th March 2013

The Institution of Civil Engineers (India)

Application form for Re-valuation
Examination : Winter 2012 Course
Roll No. Membership No Name of the Candidate Membership No. & Name of the Institutional Member

: T. Engg.

/ AMICE(I)

: : : :

Subject/s opted for Revaluation:

S.No. 1 2 3 4 Subject Code Subject Marks Obtained

Details of the Revaluation fee paid:

DD* No. ______________dated _________for Rs. _________________________ (In words)____________________ towards Revaluation fee for ___ subject/s. *drawn in favour of The Institution of Civil Engineers (India) payable at Ludhiana (Punjab). Re-valuation fee : Rs. 1000/- per subject

Date: _____________

Signature of the Candidate

___________________________________________________________________________________________
For office use only
S.No. 1 2 3 4 Subject Code Subject Marks Obtained Result after Revaluation