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The Institution of Civil Engineers (India) Application form for Re-valuation Examination : Winter 2012 Course : T. Engg. / AMICE(I) Roll No. : Membership No : Name of the Candidate : Membership No. & Name of the Institutional Member : Subject/s opted for Revaluation: S.No. Subject Code Subject Marks Obtained 1 2 3 4 Details of the Revaluation fee paid: DD* No. ______________dated _________for Rs. _________________________ (In words)____________________ towards Revaluation fee for ___ subject/s. *drawn in favour of The Institution of Civil Engineers (India) payable at Ludhiana (Punjab). Date: _____________ Signature of the Candidate ___________________________________________________________________________________________ For office use only S.No. Subject Code Subject Marks Obtained Result after Revaluation 1 2 3 4 Re-valuation fee : Rs. 1000/- per subject Last Date for submission of Re-valuation form: 25 th March 2013

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Page 1: Re Evaluation Form

The Institution of Civil Engineers (India) Application form for Re-valuation

Examination : Winter 2012

Course : T. Engg. / AMICE(I)

Roll No. : Membership No : Name of the Candidate

:

Membership No. & Name of

the Institutional Member :

Subject/s opted for Revaluation:

S.No. Subject Code Subject Marks Obtained

1

2

3

4

Details of the Revaluation fee paid:

DD* No. ______________dated _________for Rs. _________________________

(In words)____________________ towards Revaluation fee for ___ subject/s.

*drawn in favour of The Institution of Civil Engineers (India) payable at Ludhiana (Punjab).

Date: _____________ Signature of the Candidate

___________________________________________________________________________________________

For office use only

S.No. Subject Code Subject Marks Obtained Result after Revaluation

1

2

3

4

Re-valuation fee :

Rs. 1000/- per subject

Last Date for submission

of Re-valuation form:

25th

March 2013

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