THE INSTITUTION OF ENGINEERS (INDIA)

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EXAMINATION APPLICATION FORM FOR SUMMER/WINTER

EXAMINATION TYPE
NAME(in capital letters)

EXAM FEE FOR SECTION AD (INDIA/NEPAL)

RAVASAHEB GUNDU BHOLE

HOME:

FLAT NO.9,YASHADA SQUARE-I

STREET:

VISHWASHANTI COLONY, PIMPLE SAUDAGAR

CITY:

PUNE MAHARASHATRA

PIN
MOBILE NO.
E-MAIL:
MEMBERSHIP GRADE & No.
REFFERENCE NO:
AMOUNT:

411027
9923474070
bholerg@gmail.com
ST6028700
130102345400

Telephone No.

9049724151

2000

SCHEME
300
ENGINEERING BRANCH
Section A (DIP)
You have selected the following subjects(s) 301 302 304
1.Appeared previously in
with Roll No.
2.I wish to appear from Examination Centre Code No.
0
(a) Passed completely in
(b) Secured exemption from
in

with Roll No.

(term/year)

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

Full Signature of Candidate with

Date

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