The Institution of Engineers (India)

8 Gokhale Road, Kolkata 700020

EXAMINATION APPLICATION FORM FOR SUMMER/WINTER ...............

Please refer Rules : Vol I of December 2004 edition or December 2004 issue of Technicians’ Journal for Examination Code, Engineer-
ing Branch Code, Subject Codes, etc. Incomplete or illegible application shall be rejected without reference to the candidate.

Name & Address of the Candidate Membership Grade & Number

Grade Number
—

Scheme Code
(AN = 2, AD = 3, B = 4)

Engineering Branch Code

PIN (CH = 04, CV = 05, CP = 06, .....)

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 pages 60-63 of Rules : Vol I of December 2004 edition for subject code nos)

FOR SECTION B CANDIDATES ONLY

(a) Passed Section A/A(D)/B completely in Summer/Winter ............................. with Roll No. ................................
(b) Secured exemption from Section A or Sections A and B in ...................................... (term/year)
I shall abide by the Rules of the Institution Examinations as given in Vol I : Rules.

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.

RECEIPT OF EXAMINATION FORM WITH FEE

(if deposited at Headquarters Cash Counter only)

Received the Examination Form with a Demand Draft of Rs. ............................................ for Summer/Winter ...................... Examination
from ................................................................................ (T/ST/A/AM/M .................................).

Cashier’s Signature with Stamp

Vol 86, December 2005 53