Serial No.

ENGINEERS
INSTITUTE OF INDIA
India’s Best Institute for IES, GATE & PSUs

REGISTRATION CUM ADMISSION FORM

Affix passport size

Registration No. ( For office use only) Validity : recent Photograph

Select the centre for admission Date of Registration

d d m m y y y y

STUDENT / CANDIDATE’S NAME (IN BLOCK LETTER ONLY)

FATHER’S NAME (IN BLOCK LETTER ONLY)

BRANCH CODE COURSE MODULE COURSE CODE GENDER

0 Female
1 Male
1 Chemical Engineering 1 Regular Batch 1 Combined Course
2 Civil Engineering 2 Weekend Batch 2 GATE + PSUs CATEGORY
3 Computer Science & IT 3 Postal 3 GATE 0 General
4 Electronics Engineering 4 Crash-Course 4 Engineering-Service 1 OBC
2 SC
5 Electrical Engineering 5 Test-Series 5 JTO / SSC / DRDO 3 ST
6 Mechanical Engineering 6 Mock Interview 6 Crash-Course
Blood Group :
7 Instrumentation Engg. 7 Other 7 Other

MOBILE NUMBER DATE OF BIRTH

1 Passed
Date Month Year
PARENT’s PHONE NUMBER
D D -M M- Y Y Y Y 2 Appearing

Please attach Photocopies of Engineering Degree examinations certificates

Branch Institute Attended Percentage % Year

Admission Rules & Regulation

·The Management is not responsible for the loss, theft, or damage to any personal property owned or possessed by the Student,
which may be located or stored in any location of the institution.
·Once the classes for particular Batch starts, student are not about to change their course module and he/she has to pay all the
fees even he/she leaves the course in between before the due date.
·In the event a student discontinues his study for whatever reason(s), all fees paid at the time of Admission shall not be refundable
or re-adjustable. No claim will be entertained in the case of fee refund/adjustment.
·Non-payment of the prescribed fees within the due date will result in cancellation of registration to the course.
·Admission to hostel is done on the basis of availability due limited seats and it belongs to local residence. It is not right of
candidates.
·The Institute Authority can make change to the schedule of admission/classes if required without assigning any reasons.

Wrong Method Wrong Method Wrong Method Wrong Method Correct Method ENGINEERS INSTITUTE OF INDIA
61C, Kalu Sarai Hauz Khas New Delhi-110016,
Ph. 011-26514888, Website: www.engineersinstitute.com
 UNDERTAKING

This is to state that I ............................................................ son / daughter of ..............................................................resident of

........................................................................................... joining this institute with complete knowledge of the academy and of
its rule and regulation and the discipline of the institute. In case of violation of discipline and wrong behavior in any means, I shall
be terminated from institute without any claim for the refund of the fees. I confirm I hereby understand the terms and conditions of
the institution and there will be no refund of the fee once paid in any circumstances. I wish to enroll for the above program with full
interest without any problem. Engineers Institute of India-E.I.I. serves the right to publish all my future results in Audio / Visual /
Print Media. The right to publish my result belongs only to Engineers Institute of India.

...............................................
Signature of the Candidate with date

PERMANENT ADDRESS (IN CAPITAL LETTERS)

......................................................................................................................................................................................

......................................................................................................................................................................................

Email.ID.: .....................................................................................................................................................................

Phone (STD Code): ....................................................................................................PIN.

FOR OFFICE USE ONLY

Total Fee: ....................................................
Installment Charge : Rs. 500/- Per installment.

Registration fee Rs. 3000 Non-Refundable.

Receipt No. Date Amount Paid Amount Due Due Date Received by

Mode of Payment: Cash Cheque / Demand draft Online Deposite Date of Deposite

DD. No. Bank

Any Feedback :

Signature of the Admin with seal

Student ACHIEVEMENT Record

Examination( Filled by Admin ) Examination Roll No. Result / Selection Status