Fiitjee Aits Form 2015

8/10/2019 Fiitjee Aits Form 2015

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Enrolment No. :(For official use only)

(To be filled by the student)

Name of the Student :

Fathers/Guardians Name :

Mothers Name :

Date of Birth : Nationality :

Correspondence Address :

Pin :

Ph. (Res.) with STD Code : Mobile No. ** :

Permanent Address :

Pin :

Ph. (Res.) with STD Code : Mobile No. :

School affiliated to : CBSE ICSE Other (Please Specify)_____________________________

Class : IX X XI XII XII (Pass)

Science+Math/PCM (%) : X Board . % XII Board . %

Marks (if in Grades) : X Board- Science Maths XII Board- P C M

Category of Student : General Other (Please specify)____________________________

E-mail ID of the Student :

(in Block Letters)

** Please mention if you want to receive information through SMS on this mobile: Yes No

FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016

Ph: 011- 46106000 /10 / 13 / 15/ 68, All India Toll Free No. 1800 11 4242

E-mail: [email protected], website: www.fiitjee.com

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Preference of Test Centre

for AITS for JEE (Main & Advanced) :(for list of Test Centres see page no. 3)

Name of Program Enrolling for :

(for list of Programs see page no. 4)

Correspondence ProgramsENROLMENT FORM

Please Affix Your

Recent Passport SizeColour Photograph

D D M M Y Y Y Y


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Nearest relative / Guardian Address (to be contacted in case the student is not available at the above mentioned address):

Pin :

Ph. (Res.) with STD Code : Mobile No. :

Name of the School :(studying or passed)

Name of the Principal :

School Address :

Pin :

Phone No.:

Details about your Parents:

Particulars Father Mother

Name

Qualification

Occupation

Designation

Company Name

Company / Office Address

Company / Office Tel. No.

Mobile No.

E-mail (in Block Letters)

Annual Income




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Test Centres$for All India Test Series (AITS) for JEE (Main & Advanced) (only one centre can be opted):

Delhi (South), Delhi (North-West), Delhi (East), Delhi (Dwarka), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Delhi NCR (Gurgaon),

Delhi NCR (Noida), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai,

Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dehradun, Dhanbad, Durgapur, Gaya, Gorakhpur, Guwahati, Gwalior, Hisar,

Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota,

Lucknow, Ludhiana, Meerut, Mumbai (Andheri), Mumbai (Chembur), Mumbai (Kandivali), Mumbai (Navi Mumbai), Mumbai

(Thane), Muzaffarpur, Mysore, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee, Rourkela, Shaktinagar NTPC, Siliguri, Thrissur,

Trivandrum, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Visakhapatnam.

$ Above are the Test Centres for All India Test Series for JEE (Main & Advanced) only.

Note:All India Test Series (One Year & Two Year) is also available by Correspondence(All the Test Papers to be received & attempted at your home.)

Course Fee payment details :

Demand Draft No. Drawn on Bank Dated Amount

Check List (Please t ick in the box):

1. Photocopy of

X / XII Board Marksheet*VIII school final exam marksheet* (for Junior Rankers Study Material)

2. Colour Photographs (4 Passport Size)

3. Demand Draft for Course Fee

* In case of claim for scholarship, marksheet / certificate of Scholastic Achievement is to be attested by the past or present School Principal.

Note 1: Fee of any program is not refundable at any stage.

Note 2: All India Test Series is part of Rankers Study Material. You need not enrol for it separately in case you are enrolling yourself for Rankers Study Material.

Note 3: Please write your name behind your Photograph and your name & address behind the Demand Draft.

Note 4: The Demand Draft for course fee for all the above mentioned JEE programs should be in favour of "FIITJEE Limited - TS, RTPF, GMP A/c" payable at

New Delhi.

Note 5: Photocopy of this form can also be used.

Place: ______________ (Signature of the Student) (Signature of Parent / Guardian)

Date: ______________ Name _______________________________________________

Relationship with the Student____________________________

Mobile. No. of Parent / Guardian _________________________




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Fiitjee Aits Form 2015

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