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Manipal Institute of Technology, Manipal

A Constituent Institution of Manipal University

Application for Change of Branch in III Semester B. Tech.

Registration Number 1 5 0 9 0 6 2 7 0
Name SOHAM DE
(Write in capital letters)
Contact No. 7204577899

Admission Category GENERAL
(General/NRI/Others* (* Specify))
Do you wish to continue with the
branch change in case the Yes No Not Applicable
scholarship is not available
(Applicable only for SAGES /AICTE category *
admission)
Rank Secured
9103
(Manipal Entrance Exam)
Change of Branch Preferred (Please list in the order of preference – Avoid abbreviations)
1 INDUSTRIAL AND PRODUCTION ENGINEERING

2 INSTRUMENTATION AND CONTROL ENGINEERING

3 CIVIL ENGINEERING

4
5
6
7
8
9
10
DECLARATION
I, hereby declare that the information given are correct and I will abide by the rules and regulations of
Change of Branch. If the change is given, I will have no claim to go back to my originally allotted branch
later.

Date: 24/06/2017 Signature of the Student

IMPORTANT: BRANCH CHANGE CANNOT BE REVERTED
Please Turn Over

MIT/Academic/F 04/R2

Parent / SOHAM DE Guardian //////////// of Mr. this application for change of branch is made with my knowledge and consent. // ………………………………………………………………./Ms. INDRAJIT DE /// ………………………………………………………………………………. CONSENT OF THE PARENT I. of the parent/Guardian: 9490168948 Date: 24/06/2017 Signature of the Parent/Guardian ////////// IMPORTANT: BRANCH CHANGE CANNOT BE REVERTED MIT/Academic/F 04/R2 . Mr./Ms. Contact No. 4th SEMESTER ELECTRICAL AND ELECTRONICS ………………………………………………………… Engineering Branch at MIT Manipal declare that. Studying in // II semester B. Tech.