The Institution of Engineers

ECSC
( India)
8 GOKHALE ROAD, KOLKATA - 700 020

MEMBERSHIP NO.

Abbreviated Form of the Engineering

Engineering College PIN Code Number BranchCollege
CodeName Membership Serial Number

Name : S A P T A R S H I M O N D A L
(Above portion to be filled in by the Adviser of the Chapter)

Father,s Name/Husband’s Name : P R A B I R K U M A R M O N D A L

Address for Communication : V I L L A G E + P O S T - P U R G U N A , P O L I C E - S T

A T I O N - M A N T E S W A R , D I S T R I C T - P U R B A B A R D H A M A N

, P I N - 7 1 3 4 2 2

E-mail ID : s 9 9 3 2 5 9 0 1 8 8
a p t a r s h i m o n d a l 7 6 8 @g mai l.co m Mobile No. :
Date of Birth 1 2 0 7 2 0 0 4

:
Name of the Institution/ Branch of Engineering Year of Study Fees Paid (`)
Engineering College

JIS COLLEGE OF ENGINEERING ELECTRONICS AND 2ND Year 536

COMMUNICATION ENGINEERING

I hereby apply for enrolment as a member of Students’ Chapter of The Institution of Engineers(India) in accordance with the rules of the Chapter
and the Bye-laws and Regulations as they now stand or hereinafter be legally altered. I do hereby undertake that I will be governed by the
Bye-laws and Regulations of the Institution. I accept the responsibility for the accuracy of the particulars contained in the above and I agree that,
if I am enrolled, the validity of the enrolment shall depend upon the accuracy of the particulars as required under the Bye-laws. I also undertake to
abide by the conduct of rules and / or Code of Ethics that the Council may prescribe from time to time

Signature of the Applicant (in English only)

I certify the application and information featured above for consideration to induct the applicant in IEI fold as an ECSC Member of IEI

(Signature of the Adviser of the Engineering College Students’ Chapter with seal and
date)

 This portion to be retained by the Chapter

  This portion to be retained by the Student 

The Institution of Engineers The Institution of Engineers

( India) ( India)
(Established 1920, Incorporated by Royal Charter 1935) (Established 1920, Incorporated by Royal Charter 1935)
8 Gokhale Road, Kolkata 700 020 8 Gokhale Road, Kolkata 700 020

MEMBERSHIP NO.
MEMBERSHIP NO.

Engineering College PIN Code Number Branch

Abbreviated Form of the Engineering Code
College Name Membership Serial Number Engineering
College PIN Code Abbreviated Form of the Branch Membership
Number Engineering College Code Serial Number
(Above portion to be filled in by the Adviser of the Chapter) Name
Roll No. : 123211002061
This portion to be retained by the

Name : SAPTARSHI MONDAL

Branch : ELECTRONICS AND COMMUNICATION ENGINEERING
First/Second/Third/Fourth (Tick here) :Second
Student
 (Above portion to be filled in by the Adviser of the Chapter) Name of the Institution :
Name : SAPTARSHI MONDAL
Vaild upto :

Signature of Adviser with Signature of Adviser with seal

Signature of the seal Signature of the
Student Student