Manipal Institute of Technology, Manipal

A Constituent Institution of Manipal University

Application for Change of Branch in III Semester B. Tech.

Registration Number 1 5 0 9 0 6 2 7 0
Name SOHAM DE
(Write in capital letters)
Contact No. 7204577899

Admission Category GENERAL

(General/NRI/Others* (* Specify))
Do you wish to continue with the
branch change in case the Yes No Not Applicable
scholarship is not available
(Applicable only for SAGES /AICTE category *
admission)
Rank Secured
9103
(Manipal Entrance Exam)
Change of Branch Preferred (Please list in the order of preference Avoid abbreviations)
1 INDUSTRIAL AND PRODUCTION ENGINEERING

2 INSTRUMENTATION AND CONTROL ENGINEERING

3 CIVIL ENGINEERING

4
5
6
7
8
9
10
DECLARATION
I, hereby declare that the information given are correct and I will abide by the rules and regulations of
Change of Branch. If the change is given, I will have no claim to go back to my originally allotted branch
later.

Date: 24/06/2017 Signature of the Student

IMPORTANT: BRANCH CHANGE CANNOT BE REVERTED

Please Turn Over

MIT/Academic/F 04/R2
 CONSENT OF THE PARENT

I, Mr./Ms. INDRAJIT DE
/// . Parent /
SOHAM DE
Guardian
//////////// of Mr./Ms.
// . Studying in //
II

semester B. Tech. 4th SEMESTER ELECTRICAL AND ELECTRONICS

Engineering Branch at

MIT Manipal declare that, this application for change of branch is made with my knowledge

and consent.

Contact No. of the parent/Guardian: 9490168948

Date: 24/06/2017 Signature of the Parent/Guardian

//////////

IMPORTANT: BRANCH CHANGE CANNOT BE REVERTED

MIT/Academic/F 04/R2