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. E-mail :

MEMBERSHIP GRADE (T/ST/A/AM/M/F) Scheme Code Engineering Branch Code
(CH=04, CV=05, .........)

Telephone No.

MEMBERSHIP NUMBER

(AN=2, AD=3, B=4)

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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