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. Telephone No.

E-mail :

Engineering
MEMBERSHIP GRADE Scheme Code Branch Code
(T/ST/AM/M/F) MEMBERSHIP NUMBER (AN=2, AD=3, B=4) (CH=04, CV=05, .........)

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
and revised thereafter from time to time.

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.