fitjee entering form

8/22/2019 fitjee entering form

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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 XI XII XII (Pass)

Marks in Sci.+Math/PCM (%) Obtained : 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 Limited, 1st Floor, Building No.10 C, DLF Cyber City, DLF Phase-II, Gurgaon, Haryana - 122 002

Ph.: 0124 - 4885560 / 66 / 77; Fax: 0124 - 4283133; Toll Free: 1800 11 4242; E-mail: [email protected], website: www.fiitjee.com 1/4

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 FIITJEE

Please Affix YourRecent Passport Size

Colour 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 (Thane), Muzaffarpur, 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. (for centres of Concept Strengthening & Analysis Program (CSAP), please

cont act your nearest FIITJEE Cent res.)

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 (3 Passport Size & 1 Stamp 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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For JEE (Advanced), 2013

I am interested in enrolling for (Tick the appropriate box) Last date to receive completed application

All India Test Series for JEE (Advanced) 21st April, 2013

For JEE (Main & Advanced), 2014 (for Class XII & XII Pass)


Rankers Study Material (One Year Version) 31st August, 2013

One Year All India Test Series 14th October, 2013

One Year All India Test Series (By Correspondence) 21st October, 2013

For JEE (Main & Advanced), 2015 (for Class XI)


Rankers Study Material (Two Year Version) 20th September, 2013

Two Year Integrated All India Test Series 18th November, 2013

Two Year Integrated All India Test Series (By Correspondence) 25th November, 2013

For students of class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad

& Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams


Jr. Rankers Study Material 20th September, 2013



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