The National Institute of Engineering (An Autonomous Institution under Visvesvaraya Technological University, Belagavi) Recognised by AICTE, New Delhi. Grant-in-Aid by Government of Karnataka

Manandavadi Road, Mysuru – 570 008, Karnataka, India

Phone: 91-821-2480475, 2481220, 4004900, Fax: 91-821-2485802 Email : principal@nie.ac.in, principalnie@yahoo.com, web: www.nie.ac.in

APPLICATION FORM

CHANGE OF BRANCH – 2017-18

NAME OF THE STUDENT

ADDRESS & TELEPHONE / MOBILE NUMBER

USN

PRESENT BRANCH

CHANGE REQUIRED TO (in order of preference)

(i)

(ii)

SGPA I Semester II Semester

CGPA (1st Year)

Qualifying Examination Marks in (PUC / equivalent)

Physics

Mathematics Chemistry/Electronics/ Computer Sc./ Biology

Total = Challan No. & Date of Payment of Rs.100/- towards Application Fee (Enclose the copy to Challan)

Signature of the Parent / Guardian Signature of the student

THE NATIONAL INSTITUTE OF ENGINEERING THE NATIONAL INSTITUTE OF ENGINEERING THE NATIONAL INSTITUTE OF ENGINEERING MYSURU - 570008 MYSURU - 570008 MYSURU - 570008

Ch. No. : Ch. No. : Ch. No. :

(Bank Copy) (College Copy) (Student Copy)SYNDICATE BANK, NIE CAMPUS BRANCH, MYSORE SYNDICATE BANK, NIE CAMPUS BRANCH, MYSORE SYNDICATE BANK, NIE CAMPUS BRANCH, MYSORE

A/c No.201-12230 A/c No.201-12230 A/c No.201-12230

Date…………………… Date…………………… Date…………………… Date…………………… Date…………………… Date……………………

Name of the Student(in block letters) Name of the Student(in block letters) Name of the Student(in block letters)

………………………………………………………………………… ………………………………………………………………………… …………………………………………………………………………

Change of Branch: Course : BE Change of Branch: Course : BE Change of Branch: Course : BE

Semester : III rd Branch ………………………… Semester : III rd Branch ………………………… Semester : III rd Branch …………………………

DETAILS: DETAILS: DETAILS:

Application Fee : 100/- Application Fee : 100/- Application Fee : 100/-Application Fee : 100/- Application Fee : 100/- Application Fee : 100/-

Amount Rs. (One Hundred Only) Amount Rs. (One Hundred Only) Amount Rs. (One Hundred Only)

Checking Officer Signature of the Student Checking Officer Signature of the Student Checking Officer Signature of the Student