Reg.

No 1M-1/11584/88 S-1/Laxmi Complex, opp ONGC Workshop, Sabarmati, Ahmedabad (Gujarat) -380 005 Phone : 079- 27506381, 09979607802Fax : 079-27506381 Website : http://www.amieinstitute.com E-mail : amiei@rediffmail.com

AMIE INSTITUTE

Affix Recent Passport Size Photograph

APPLICATION FOR ADMISSION

Form No.

Mechanical Engineering Degree Level Diploma Level

Name in full Mr / Ms. (Block Letters) Home Address:

Civil Engineering Degree Level Diploma Level

Architectural Engineering Degree Level Diploma Level

Membership No.

First

Middle

Surname

Pin : Phone No: STD Code Office Address: Pin : Phone No: STD Code Date of Birth : (O) Occupation : (R) E-mail : (M) (O) (R) (M)

ACADEMIC INFORMATION

Std

Name of the School/College

Year of Passing

Exam Authority

% Obtained

I hereby declare that the information given in this Application Form is correct to the best of my knowledge and belief. I have read all the rules and regulations and promise to abide by them. Fee once paid is non refundable under any circumstances. I don't have any right to claim for fee paid. Its my moral duty & obligation to pay all the fee in time.

Place :

Date :

Signature (Student) FOR OFFICE USE ONLY

Signature (Parent)

Reg. No : Representative's Name:

Documents checklist: a) Five passport size photographs b) 10th marksheet & Certificate c) 12th marksheet & Certificate d) ITI / NCVT Certificates Received

Course :

Date :

Received e) Degree certificate f) Diploma (all semesters) marksheets g) Diploma Passing Certificate h) Leaving Certificate / Date of Birth Certificate