Corporate Office"SANKALP", CP-6, IndraVihar, Kota (Rajasthan)-324005Trin : +91-744-516-2200, 515-6100 E-Mail : dlp@allen.ac.in

APPLICATION FORMNTSE TEST SERIES FOR STAGE-II

Academic Session 2016-17

ALLEN Form No. CCP DLP

DEMAND DRAFT DETAILS

No. : _____________________________

Dated : ___________________________

Bank : ___________________________

__________________________________

Amount (in Rs.) : __________________

Amount (in Words) :________________

__________________________________

Test Center Name : ________________________________________________________________________

Student Name : ________________________________________________________________________

Father’s Name : ________________________________________________________________________

Mother’s Name : ________________________________________________________________________

Date of Birth :

Gender (Tick) : Male Female

Category (Tick) : GEN SC ST EX PH OBC SOBC

Postal Address : ________________________________________________________________________

________________________________________________________________________

__________________________________ City__________________________________

State : __________________________________ Pin Code _____________________________

Contact No. : (STD Code)___________________ (Phone No.)_________________________________

Mobile No.(s) : (1)__________________________________(2)_________________________________

E-mail Address : (For important updates)___________________________________________________

D D M M Y Y Y Y

FEE STRUCTURE*

Course Name Total Amount Payable (Inclusive Service Tax)Course Code

(ENGLISH Medium Only)

Affix here a Recent

Passport Size

Color photograph.

Please do not staple.

DECLARATION I hereby declare,

1. that I have read the instructions of Test Series and I agree to abide by the Rules & Regulations as amended by institute time to time.

2. that I am seeking admission in my own interest and accord.

3. that all information furnished by me in Application Form etc. is correct. I understand that in the event of any information found to be

incorrect of false, my admission may be cancelled without any refund of fee.

4. that I will be responsible for my rustication on behalf of my misconduct / misbehave at test center.

6. that in case of my selection in NTSE Exam, the institute reserves the right to use my information for publicity.

FORM No.

(For Office use only)

500/-

5. that I will submit the photocopy of NTSE 2017 Stage - I & II Admit Card at Test Center.

Date : / / 20 Signature of Candidate

4171

Are you CCP/DLP Student of ALLEN during session 2016-17 ?If yes, please complete the following information

*CCP/DLP Students of Session 2016-17 need not to pay Fee for this Test Series.

NTSE 2017 Stage-I Roll No.: NTSE 2017 Stage-II Roll No.:

IMPORTANT : Attach zerox copy of your NTSE 2017 Stage - I Admit Card with this form. Failing which your form may not be processed.

Place : ___________ Signature of Parent/Guardian

This Application Form is also available on our website : www.dlp.allen.ac.in

(In BLOCK Letters)

NTSE TEST SERIES FOR STAGE-II 2017

FORM No.

(For Office use only)