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THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS

2, Institutional Area, Lodhi Road, New Delhi-110003.

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..
E-mail Id
{Please write own address in capital letters with pin code number}

.
(Signature of the Candidate)
Date:

{COMPLETION Sr. NUMBER}

Address:

( For Office Use Only )

..
.
..
..PIN.

Enclosed :Bank Draft No...DateRs. 4,500 /- (w.e.f. 1st 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

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THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, Institutional Area, Lodhi Road, New Delhi-110003.
APPLICATION FOR TRANSFER FROM STUDENT TO ASSOCIATE MEMBER
( FOR AMIETE PASSED STUDENTS ONLY )

Membership No. SG

Roll No

AMIETE EXAMS PASSED IN JUNE / DECEMBER - .

Stream- ( ET / CS / IT)

Name --------------------------------------------------------------Address------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------PIN------------------------ BANK

Rs. 4,500 /- (w.e.f. 1st Apr 2015)

DRAFT No.-------------------------------Date..for

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

..
{Signature of the Candidate}
Date :.

E-mail Id..

FOR OFFICE USE ONLY

1. Completion No Stream.
2. Final Grade sheet No..
3. Original Certificate No .

PC Issued on.. by.

Dispatched on by
Sent / Issued on by....

Action Taken by

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THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, Institutional Area, Lodhi Road, New Delhi-110003.

IMPORTANT
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

Class and Membership No.

To be filled in by the office
In case of New Joining )

Category

Signature

Membership Number

Name
( as to appear in your life membership card maximum 25 characters including spaces)
Date of Birth
D
Address

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------PIN CODE----------------------------

Telephone(s)

(Off) --------------------------------------------(Resi.)---------------------------------------------

Mobile Number :
E-mail Id

--------------------------------------------Fax

----------------------------------------------

---------------------------------------------------------------------------------------------------

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THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, Institutional Area, Lodhi Road, New Delhi-110003.

UNDER TAKING
DIPIETE- { ET / CS }
(Please tick one )

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..

...
(Signature of the Candidate)

E-mail 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. .datefor

Rs. 5,800 /=
Name of the Bank.
On Line Payment Trxn Id : Date: Rs. .
Dispatched details: { For Office Use Only }

Provisional Certificate Nodt...by..

Final Grade sheet Nodt...by..
Final Certificate No..dt...by..

Action Taken by

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THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, Institutional Area, Lodhi Road, New Delhi-110003.
APPLICATION FOR TRANSFER FROM STUDENT TO DIP IETE MEMBER
( FOR DIPLOMA IETE PASSED STUDENTS ONLY )
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. .

-----------------------------------(Signature of the Candidate)

E-mail Id..

Date:

FOR OFFICE USE ONLY

Application No

Completion Sr. Number

Receipt No...

Original Certificate No.

Action Taken...

Final Grade Sheet No..

Dispatched / Issued on