UNDERTAKING AMIETE-{ ET/ CS / IT } ( Please tick one )

Transcription

1 Page-1 UNDERTAKING AMIETE-{ ET/ CS / IT } ( Please tick one ) Membership No. SG. June or Dec :.. { Completion Year } 1. I (Name) have completed AMIETE (Stream- ) during June or Dec (year)... examination. 2. I do not want to appear for improvement in any subject and my membership is valid till 3. I understand that once Provisional Certificate / Consolidated Grade sheet & Original Certificate is issued to me, I will not be eligible to appear for any improvement. Tel./ Mobile No.. Id. Date: {Please write own address in capital letters with pin code number} {COMPLETION Sr. NUMBER} Address: ( For Office Use Only )...PIN. Enclosed :- Bank Draft No...Date Rs. 4,500 /- (w.e.f. 1 st Apr 2015) Name of the Bank. On Line Payment Trxn Id :.Date:..Rs Dispatched details: { For Office Use Only } Provisional Certificate No..dated. by. Final Grade sheet No...dated. by. Final Certificate No....dated. by... Action taken by

2 APPLICATION FOR TRANSFER FROM STUDENT TO ASSOCIATE MEMBER ( FOR AMIETE PASSED STUDENTS ONLY ) Page-2 Membership No. SG AMIETE EXAMS PASSED IN JUNE / DECEMBER -. Roll No Stream- ( ET / CS / IT) Name Address PIN BANK DRAFT No Date..for Rs. 4,500 /- (w.e.f. 1 st Apr 2015) Name of the Bank On Line Payment Trxn Id :.Date :..Rs.. against application fee, transfer fee and membership attached herewith. DECLARATION BY THE CANDIDATE I declare that the above information is accurate to the best of my knowledge and I am of Nationality. I further agree that in the event of my election to ASSOCIATE MEMBER OF THE INSTITUTION OF ELCTRONICS AND TELECOMMUNICATION ENGINEERS, I will be governed by the Constitution as it is now, or as it may hereafter be altered, and that, I will advance the objects of the Institution as far as shall be in my power, provided that whenever I shall signify in writing to the Secretary General that I am desirous of withdrawing from the Institution. I shall after the payment of any arrears which may be due from me at the period, be free from this obligation. Tel/ Mobile No Id.... {Signature of the Candidate} Date :. FOR OFFICE USE ONLY 1. Completion No Stream. PC Issued on.. by. 2. Final Grade sheet No.. Dispatched on by 3. Original Certificate No. Sent / Issued on by... Action Taken by

3 IMPORTANT Page-03 TO BE FILLED IN BY THE MEMBERS WHO OPT FOR LIFE MEMBERSHIP OF THE INSTITUTION (The Life Membership Card will be issued to members on receipt of Full Life Membership Fee) Please paste your Passport size photograph and make Signature on the box provided. Photograph Signature Class and Membership No. To be filled in by the office In case of New Joining ) Category Membership Number Name ( as to appear in your life membership card maximum 25 characters including spaces) Date of Birth D D M M Y Y Y Y Address PIN CODE Telephone(s) (Off) (Resi.) Mobile Number : Fax Id

4 UNDER TAKING DIPIETE- { ET / CS } (Please tick one ) Page-1 Membership No. SD- June or Dec :.. {Completion Year} 1. I (Name) have completed DIPIETE (Stream- ) during June / Dec (year)... examination. 2. I do not want to appear for improvement in any subject and my membership is valid till. 3. I understand that once Provisional Certificate / Consolidated Grade Sheet & Original Certificate is issued to me, I will not be eligible to appear for any improvement. Tel./ Mobile No.. Id... Date: {Please write own address in capital letters with pin code number}.. {COMPLETION Sr..NUMBER} Address: ( For Office Use Only )...PIN. Enclosed :- Bank Draft No..date for Rs. 5,800 /= Name of the Bank. On Line Payment Trxn Id : Date: Rs.. Dispatched details: { For Office Use Only } Provisional Certificate No dt...by.. Final Grade sheet No dt...by.. Final Certificate No..dt...by.. Action Taken by

5 APPLICATION FOR TRANSFER FROM STUDENT TO DIP IETE MEMBER ( FOR DIPLOMA IETE PASSED STUDENTS ONLY ) Page-2 Name : Address : Pin Membership No. SD. Roll No. DIP IETE EXAM ( ET / CS ) PASSED IN JUNE / DECEMBER BANK DRAFT No Date for Rs. 5,800 /- On Line Payment Trxn Id: Date..Rs. against application fee, transfer fee and membership fee attached herewith. DECLARATION BY THE CANDIDATE I declare that the above information is accurate to the best of my knowledge and I am of..nationality. I further agree that in the event of my election to DIP IETE MEMBER OF THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS, I will be governed by the Constitution as it is now, or as it may hereafter be altered, and that, I will advance the objects of the Institution as far as shall be in my power, provided that whenever I shall signify in writing to the Secretary General that I am desirous of withdrawing from the Institution. I shall after the payment of any arrears which may be due from me at the period, be free from this obligation. Tel/Mobile No Id.. Date: FOR OFFICE USE ONLY Application No Receipt No... Action Taken... Completion Sr. Number Original Certificate No. Final Grade Sheet No.. Dispatched / Issued on