ENROLMENT FORM

THE INSTITUTE OF COMPUTER ENGINEERS (INDIA)

ENROLMENT FORM

NAME (IN BLOCK LETTER)*

FATHER’S/ GUARDIAN’S NAME (IN BLOCK LETTER)*

FATHER’S/ GUARDIAN’S OCCUPATION

COURSE

GENDER

DATE OF BIRTH

LOCAL ADDRESS (POSTAL)*

CONTACT NUMBER*

PARENT’S CONTACT NUMBER*

EMAIL ID*

GENERAL/ ST/ SC/ OBC

YEAR OF PASSING (10TH)*

% OF MARKS (10TH)*

BOARD/UNIVERSITY (10TH)*

YEAR OF PASSING (12TH)*

% OF MARKS (12TH)*

BOARD/UNIVERSITY (12TH)*

YEAR OF PASSING (GRADUATION)

% OF MARKS (GRADUATION)

UNIVERSITY (GRADUATION)

DECLARATION

I hereby declare that the particular furnished above are true to the very best of my knowledge and belief and if admitted to the course I shall abide by the rules & regulations of the institute. I also declare that on admission I will submit myself to the disciplinary jurisdiction of the Head and any other Auority of the institute who may be vested with the auority to exercise deiipline. I have read the prospectus and agreed with its terms ad conditions.

NOTE: Admission form fee Rs.100/- will be charged at the time of admission. After enrolment the payment link will be send to your email id and mobile. After successful payment, candidate has to send the payment detail at institute email id ([email protected]). After that your admission will be confirmed and other details will be send to your email id.

Browse Photo (jpg/ jpeg/ png) <= 1MB

Browse Signature (jpg/ jpeg/ png) <= 1MB

Scan copy 10th Certificate (jpg/jpeg/png)<=1MB

Scan copy 12th Certificate (jpg/jpeg/png)<=1MB

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