Name of the College/Institution_________________________________________

S.N.
Membership
Name of
Fathers Name Date of Birth
Residential
N. (will be
Student
(dd-mm-yyyy)
Address
allotted By
IETE HQ)

IETE Centre affiliated to_______________________

E-mail Id
Contact No. Study Course &
Year Branch /
Stream

CHERRY JAIN MR. RAVINDRA

KUMAR JAIN

05-08-1994

B-251,LOD
cherryjain08051994@g
MINAL
mail.com
RESIDENCY, JK
ROAD,
BHOPAL,MP

9926296640 II

BE(ECE)

MARIYA ZEDI MR. AKHTAR

ZEDI

06-02-1992

54/4,AKHTARM mariee.khan@gmail.com
ANZIL NADEEM
ROAD,BHOPAL,
MP

7489238281 II

BE(ECE)

NAMRAH
KHANAM

MR. KHWAJA
24-05-1993
MOHD. YAQOOB

H.NO-18,
nikskhanam63@gmail.c
STREET NO-1,
om
RAITGHAT,BHO
PAL,MP

8251881315 II

BE(ECE)

PRATIBHA
KUMARI

MR.PREMLAL
SINGH

SIRTS GIRLS
HOSTEL,
AYODHYA BY
PASS ROAD,
BHOPAL,MP

pratibhakumari0501@g
mail.com

7415175829 II

BE(ECE)

16-09-1993

Photo

I here certify that the above is the list of bonafide students of _______________________ College/Institution and the information given is correct as per the
college records.
Name of Co-ordinator : ________________
Designation : ____________________
IETE membership category & number (if any) : ____________
Mobile Phone number : _________________
Email Id : ______________________
Date : ______________
Details of Payment
Amount (Rs) : ____________________
DD number / NEFT Transfer (Transaction Ref. N.) : _______________
Date of Payment : ______________________