Enrollment Form - FIITJEE Limited - For IIT-JEE, NTSE ...fiitjee.com/FTRE11res10Jan12/Enrollment...

National Admissions Office : FIITJEE House, 29 - A, Kalu Sarai, Sarvapriya Vihar, New Delhi - 110 016

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

Fax : 011 - 26513942 Website : www.fiitjee.com

E n r o l l m e n t F o r m

Enrollment Number (for official use only)

( f o r C l a s s r o o m / I n t e g r a t e d S c h o o l P r o g r a m s )

2

Enrollment Form

Program Name Program Code

For Admission in Class 6th

LITTLE GENIE - One Year Foundation Program for NTSE & Jr. Science Olympiad-Regular Week Contact Classes 6051

LITTLE GENIE - One Year Foundation Program for NTSE & Jr. Olympiads-Sunday Contact Classes 6053

Admission to Class VI of FIITJEE World School at Hyderabad 6014


UDAYA Plus - Two Year Integrated School Program for NTSE 7010

UDAYA - Two Year Classroom Program for NTSE-Regular Week Contact Classes 7051

UDAYA - Two Year Classroom Program for NTSE-Weekend Contact Classes 7052

UDAYA - Two Year Classroom Program for NTSE-Sunday Contact Classes 7053

Admission to Class VII of FIITJEE World School at Hyderabad 7014


UDAYA - One Year Classroom Program for NTSE-Regular Week Contact Classes 8051

UDAYA - One Year Classroom Program for NTSE-Weekend Contact Classes 8052

UDAYA - One Year Classroom Program for NTSE-Sunday Contact Classes 8053

Admission to Class VIII of FIITJEE World School at Hyderabad 8014


SUPREME - Four Year Integrated School Program for IIT-JEE 9020

Four Year Classroom Program for IIT-JEE - Regular Week Contact Classes 9061

Four Year Classroom Program for IIT-JEE - Weekend Contact Classes 9062

Four Year Classroom Program for IIT-JEE - Sunday Contact Classes 9063

USA UnivQuest - Four Year Integrated School Program (for Admission to US Universities) 9021

USA UnivQuest - Four Year Classroom Program (for Admission to US Universities) 9042

Admission to Class IX of FIITJEE World School at Hyderabad 9014


Three Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1061

Three Year Classroom Program for IIT-JEE - Weekend Contact Classes 1062

Three Year Classroom Program for IIT-JEE - Sunday Contact Classes 1063

USA UnivQuest - Three Year Classroom Program (for Admission to US Universities) 1042


PINNACLE - Two Year Integrated School Program for IIT-JEE 1110

PINNACLE - Two Year Integrated School Program for AIEEE 1120

Two Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1151

Two Year Classroom Program for IIT-JEE - Weekend Contact Classes 1152

Two Year Classroom Program for IIT-JEE - Sunday Contact Classes 1153

Two Year Classroom Program for IIT-JEE – Special Weekend Contact Classes 1154

Two Year Classroom Program for AIEEE - Regular Week Contact Classes 1171

Two Year Classroom Program for AIEEE - Weekend Contact Classes 1172

Two Year Condensed Classroom Program for IIT-JEE -Regular Week Contact Classes 1161

Two Year Condensed Classroom Program for IIT-JEE -Weekend Contact Classes 1162

Two Year Condensed Classroom Program for IIT-JEE - Sunday Contact Classes 1163

USA UnivQuest - Two Year Integrated School Program (for Admission to US Universities) 1111

USA UnivQuest - Two Year Classroom Program for Science Stream (for Admission to US Universities) 1142

USA UnivQuest - Two Year Classroom Program for Non-Science Stream (for Admission to US Universities) 1143


One Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1251

One Year Classroom Program for IIT-JEE - Weekend Contact Classes 1252

One Year Classroom Program for IIT-JEE - Sunday Contact Classes 1253

One Year Classroom Program for IIT-JEE - Regular Week + Sunday Contact Classes 1254

One Year Classroom Program for AIEEE - Regular Week Contact Classes 1271

One Year Classroom Program for AIEEE - Weekend Contact Classes 1272

Special Weekend Classroom Program for IIT-JEE 1262

Intensive Contact Program for IIT-JEE 1281

Super Rank Enhancement Classroom Program for IIT-JEE 1282

Crash Course for AIEEE 1286

For Admission After Class 12th

One Year Extended Classroom Program for IIT-JEE - Regular Week Contact Classes 1351

One Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1361

Special Classroom Program (for Ex-FIITJEEians) 1362

One Year Classroom Program for AIEEE - Regular Week Contact Classes 1371

Intensive Contact Program for IIT-JEE 1381

Super Rank Enhancement Classroom Program for IIT-JEE 1382

Crash Course for AIEEE 1386

Classroom / Integrated School Programs

Please affix the 2nd passport size colour

photograph of the student here

Please affix the 3rd passport size colour


Please affix the stamp size colour


Please submit 3 additional passport

size colour photographs with this

Enrollment Form

3

Enrollment Form

Please Note :v Check the availability of the program at your preferred FIITJEE centre before making a choice.v Make a photocopy of this form after filling the required information and before submitting it to FIITJEE.v Log on to www.fiitjee.com/regupdate.htm to update your Contact Details online using Registration Number and web access code printed on your Hall Ticket.

Items required to be submitted along with this form :v Six identical passport size colour photographs of the student (One photograph should be pasted on this page, Two on the previous page and Three photographs should be submitted along with this Enrollment Form).v One stamp size photograph (should be pasted on the previous page).v Admission Test / FTRE / FTSE / Fortunate - 40 Hall Ticket (in Original).v Admission offer letter (in Original).v Any one of the following documents : n Photocopy of School ID card with photograph or n Photocopy of last Board or School Marksheet supported by any Identity Proof of student or n Photocopy of Transfer Certificate or n Bonafide certificate issued by the Principal of School with student’s photograph

Original should be presented for verification at the time of admission.

Test date : _________________________________________________________

Registration Number (as mentioned on the Hall ticket) :___________________________________________

Study centre : _________________________________________________________

Program Name / Code : ________________________________________ Code : __________

Scholarship Awarded % (if applicable) : ___________________________________________

Student Name (in Block Letters) : _______________________________________________________________

Date of Birth : ________/_______/________________ E-mail ID :___________________________________________

Mailing Address : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

Contact No (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________

Permanent Address (if any) : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin :_________________________________

Contact No. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________

School/College Last Attended / Presently Attending : _____________________________________________________________________

Address : ______________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

(a) Father‘s Name : _____________________________________ Qualification : ___________________________________

Occupation : Business � Govt. Service � Pvt. Service � Others (please specify) : __________________________

Name of the Company / Office : _______________________________________________________________________________________

Nature of Business / Job : _____________________________________ Designation : ___________________________________

Department : ________________________________ Contact No (office) : ____________________________________

Office/Business Address : ______________________________________________________________________________________

_________________________________________________________________________________ Pin : ________________________________

E-Mail ID : ________________________________________ Mobile No : __________________________________

(b) Mother‘s Name : _____________________________________ Qualification : ___________________________________



Nature of Business / Job : ___________________________________ Designation : _____________________________________

Department : ________________________________ Contact No (office) : ____________________________________

Office/Business Address : ______________________________________________________________________________________

_________________________________________________________________________________ Pin : ________________________________


Please affix the 1st passport size colour


4

Enrollment Form

(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteller)

Local Guardian’s Name : ________________________________________________ Qualification : ________________________



Nature of Business / Job : _________________________________________ Designation : _______________________________

Department : ________________________________ Contact No (Office) : _________________________________

Office/Business Address : _______________________________________________________________________________________

_________________________________________________________________________________ Pin :_________________________________


Mailing Address : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ Pin: _________________________________

(d) Details of the Sibling(s) (if applicable)

1. Name : _______________________________________________________________________________________

Class studying in : ___________________________ Enrollment No. (if enrolled with FIITJEE) :_________________________

2. Name : _______________________________________________________________________________________


3. Name : _______________________________________________________________________________________


Name of the Examination(s) Board Year of passing / appeared TotalAggregate %

(PCM) / (Science + Math) %

Details of the examination(s) of the class last passed / currently studying

Detail(s) of Demand Draft(s) / Pay Order(s)

S. No. Instrument Number Dated Issuing Bank & Branch Amount

1

2

3

4

Total

Fee Details : Fee Plan opted (√): I � II � III �

Fee Plan Code : _______________________________________ (please refer course fee Annexure)

5

Enrollment Form

Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted)

S. No. Instrument Number Dated Issuing Bank & Branch Amount

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Total

Student’s Signature Signature of Father / Mother / Legal Guardian

Name : _________________________________ Name : _________________________________

Date : __________________________________ Date : __________________________________

Place : __________________________________ Place : __________________________________

6

Enrollment Form

Important Information for Students (and their parents / legal guardians)

1. Before taking admission each candidate, his/her parents & legal guardians are required to -

(a) Go through the FIITJEE leaflet/brochure/information booklet, word of advice, selection letter & website thoroughly. Other than these no other verbal assurance of any kind is given by FIITJEE.

(b) It is advised that student undergoes a comprehensive Medical Examination to ensure that he/she is physically & mentally fit to take the rigors of preparing for a competitive exam including but not limited to IIT-JEE, AIEEE etc. as the case may be.

(c) Meet few FIITJEE students successful in IIT-JEE / NTSE / AIEEE etc & learn what made them successful. What was the contribution of FIITJEE in their success? Also meet a few FIITJEE students not successful in IIT-JEE / AIEEE /NTSE & learn why they could not qualify IIT-JEE / AIEEE / NTSE.

We highly advise that you also talk to non- FIITJEE students both successful in IIT & the unsuccessful ones, to form a clear opinion regarding what a coaching institute can do for you.

Please do not take admission at FIITJEE if you think FIITJEE is not the best for IIT-JEE coaching.

An intelligent student having aptitude & analytical skills for IIT-JEE / NTSE etc has to have self study for at least 3 hrs. for every hour taught at FIITJEE. Needless to say if you have not been a highly analytical student you have to put in even greater efforts.

IIT-JEE is a different exam where you will feel lost if you do not focus on fundamentals and / or you do not develop / have high analytical skills. Any amount of effort will be in vain without high analytical skills. Admission at FIITJEE does not mean that you have high analytical skills. FIITJEE teachers will guide you in such a way that you can improve your analytical skills tremendously, whether it happens or not will depend upon you. The only way to improve your analytical skills & your chances to get through IIT-JEE/NTSE etc is to solve each & every problem in FIITJEE assignments yourself. You may have to make several attempts & even go back to your basics to refresh them to solve a particular problem. It is this intensity & quality of effort which will help you develop good analytical skills.

In the end, remember while anyone can appear in IIT-JEE or pretend to prepare but only the ones who walk the right path succeed. FIITJEE has no magic potion to make you successful. Besides, coping up with school / college & IIT-JEE studies will challenge every bit of your mental & physical energies.

2. FIITJEE starts making arrangements of infrastructure, faculty & other resources about 6 months before commencement of financial year. FIITJEE admits students as per its capacity plans, (subject to unforeseen circumstances & usual organizational risks) therefore each student taking admission has to pay complete fee under all circumstances i.e. even if he/she discontinues for any reason whatsoever or parents/guardians be transferred. Not all students who sit in our admission test are offered admission therefore you & parents have to be very sure before taking admission as you have to pay complete fee under all circumstances.

Once a class starts FIITJEE does not admit any students. Therefore, any vacancy created by a student leaving cannot be filled up. Since FIITJEE has to source infrastructure, faculty etc. in advance, loss of fees of students leaving after taking admission will compel the institute to enhance fees for next batch of students which is unfair to them. Therefore, students/parents must clearly understand this important aspect and take

admission only if they are fully satisfied.

Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you

Declaration:

1. I hereby declare that the information furnished on the enrollment form etc. is correct to the best of my knowledge and belief.

2. I/we clearly understand that FIITJEE on completion of topics to be covered by FIITJEE in XI as per its plan will do goal refocusing for all Two Year Classroom Program students including PINNACLE program students to help each student achieve maximum possible success. This means that some students based on their performance, may have to predominantly focus on exams other than IIT-JEE.

3. If any discrepancy in this information or otherwise is found at any stage of my association with FIITJEE, any action deemed fit by FIITJEE including my expulsion from the institute may be taken against me. In such a case I or my parents/guardian shall have no claim for any type of compensation/refund of fees.

4. I am taking admission in FIITJEE with the consent of my Father/Mother/Legal Guardian and after being satisfied in all respects.

5. I understand that if I fail to complete/submit all remaining formalities/documents, if any, upto two days prior to the start of the classes, unless otherwise allowed in writing, I shall not be allowed to attend the classes till the needful is done, and in that case I or my father / mother / legal guardian shall have no claim for refund of fees or any compensation, including in studies.

6. I understand that if I leave the institute before completing the full course for any reason whatsoever, including transfer of my father / mother / legal guardians / ill health of myself or any other member of the family or my admission in any institute / course / engineering college etc., or my studentship is cancelled because of misconduct etc. I or my father/mother/legal guardian shall have no claim for refund of fees.

7. In addition to the above, I understand without any ambiguity that the fee once paid is not refundable at all, whatever the reasons be, nor is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student.

8. I will follow all rules & regulations of the associate school of FIITJEE Limited allotted to me in principle. And I agree that decision of FIITJEE management relating to all Terms & Conditions, Rules & Regulations of the associate school will be final and binding in all circumstances and situations, whatsoever.

9. It is understood that this admission is valid only for the course and the duration to which I am taking admission and I/We (the student and the parents) shall not claim/request for adjusting the fees to any other course or duration.

10. I/We undertake that the course material whatever is given to the student during the course of study at FIITJEE, shall not be given to any one else for any purpose whatsoever.

7

Enrollment Form

11. FIITJEE has enjoyed great relationship with students and parents. Almost all students in every class and every program have been succeeding in coping up with huge pressure of competitive exams along with school studies. In few cases where some students do discontinue because they are not able to cope up with competitive exam preparations along with school studies, the parents have continued to support the good work of FIITJEE.

What will constitute deficiency in service ?

If the average feedback of the particular subject teacher goes below 70% in the Feedback Form “Annexure - FB” (attached herewith), then the said teacher will be considered to teach below the minimum FIITJEE Standard. If a teacher gets less than 70% feedback in two consecutive periods then his / her teaching will be considered unsatisfactory by high FIITJEE standards..

12. I/We have fully satisfied ourselves with regards to quality and excellence of teaching at FIITJEE from all available information/sources and have decided to study only at FIITJEE. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option at our own sweet will and convenience without any pressure/coercion from any one.

13. I/We agree to give a copy of the JEE Admit Card of the student by 25th March of the concerned JEE year to FIITJEE.

14. I/We understand that (in case of scholarship student), if we fail to give the JEE admit card by 25th March of the concerned JEE year, FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student / parents / legal guardian will have no objection for the same.

15. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word of mouth among the students. I/We will fully cooperate to achieve this objective including giving the JEE Admit Card before 25th March of the concerned JEE year and signing the letter of appreciation lauding FIITJEE efforts.

16. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further agree to give a letter of appreciation to FIITJEE for the outstanding result.

17. If a student is awarded scholarship by FIITJEE and does not perform at a similar level after joining FIITJEE Classroom / Integrated School Program then a probe may be lodged to find out if the student got scholarship on his / her own merit or by using any unfair means. Parents and Guardians of the student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and also a compensation of Rs. 10 Lacs, if the investigating committee concludes that student had not secured the scholarship on his / her own merits.

Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.

18. I have read the above as well as the current FIITJEE Brochure carefully and have understood it clearly. I have also received a copy of this Enrolment Form, all other admission documents and FIITJEE Brochure for my future reference and timely compliance.

19. I / We, the parent/guardian and/or the student, hereby severally and jointly declare unambiguously that I/we have read and understood all the clauses contained in the Declaration and agree to abide by them without any reservation or ambiguity.

20. I / We further declare that the above named student is taking admission in the program as mentioned on page 3 having considered everything material, on his / her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission of the father/mother/legal guardian without any coercion from any side. Further I/We understand that the student is required to work hard to attain the average standard of the batch allotted in order to cope up with studies and put in extra efforts if lagging behind in any subject/topic.

21. I / We further undertake to ensure that cheques/drafts including post dated cheques if any given by us will be honored by our bankers. In the event of these cheques/drafts being dishonored, FIITJEE is at liberty to initiate any action against us including legal proceedings to include invoking provisions of section 138 of Negotiable Instruments Act.

22. I have read the above carefully and have understood it clearly. I have kept a photocopy of all the pages of this enrollment form including this declaration and Annexures “A”, “B”, “C” & “D” for my future reference and timely compliance.

23. I know that registered office of FIITJEE Ltd. is situated at New Delhi.

24. I promise to abide by all rules and regulations of FIITJEE declaration, in letter and spirit.

25. In the event of any dispute regarding the interpretation of clauses of enrolment form or any claim etc. arising out of taking the admission in FIITJEE Ltd., the matter shall be referred to the Sole Arbitrator appointed by the Management of FIITJEE Ltd. The decision of the arbitrator shall be final & binding on both parties. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or its sister concern, and for reasons of having any prior linkage with the company. The venue of Arbitration shall be Delhi / New Delhi only.

26. Subject to clause 25 above, I/We (the student and the father/mother/legal guardian) understand that in case of any legal dispute, the jurisdiction will be an appropriate court/forum in Delhi/New Delhi only and I shall not take recourse to such an action in any other court/forum any where else. In case I do, I shall inform the relevant court/forum regarding this jurisdiction constraint.

Additional declaration for Integrated School Program Students only :

27. I / We (Student and the parent) am/are joining FIITJEE’s Integrated School Program only after satisfying myself / ourselves about the structure of program. I’ll fully abide by the rules and regulations of the school. I also understand that in the event I am expelled from the school on any

disciplinary ground I’ll raise no claim from FIITJEE for any academic and/or financial loss including course fee.

Student’s Signature Signature of Father / Mother / Legal Guardian

Name : _________________________________ Name : _________________________________

Date : __________________________________ Date : __________________________________

Place : __________________________________ Place : __________________________________

8

Enrollment Form

(To be struck off, if not applicable)

As my father / mother / legal guardian do(es) not reside in Delhi and I have no local guardian.

I own all responsibility on their / his / her behalf.

Date : _________________________________ Student’s Signature : ________________________________

Place : _________________________________ Name : _______________________________________________

(Declaration to be given if the Enrolment form is not signed by the Father/mother/legal guardian at the time of admission)

I have received an extra copy of this Enrolment Form, which I shall send to my father/mother/legal guardian and submit to FIITJEE

within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities in

writing, my admission shall be liable to be cancelled and I or my father/mother/legal guardian shall have no claim for refund of fees

or any other compensation of any type.

Date : _________________________________ Student’s Signature : _________________________________

Place : _________________________________ Name : ________________________________________________

Instruction : After filling-up annexure “A”, “B”, “C”, “D” please retain photocopy of the same before submitting at the FIITJEE

Checklist : 1. Demand Draft(s) / Pay Order(s) for the fee. 2. Local / at par post dated cheque(s)

3. Enrolment Form duly filled in. 4. Annexure “A” to “D”

5. Colour Photographs (a) Passport size (Six)

(b) Stamp size 2.5 x 2 cm. (One)

9

Enrollment Form

Annexure “A”

PARENT DATA SHEET

(CONFIDENTIAL)

Dear Parent /Guardian

The right and accurate feed back of your ward/student will give us an opportunity to understand the student better which will help us

in providing better support & education. This information will be confidential.

1. Name of the Student : ______________________________________________________________________________

2. Father’s/Guardian’s Name : ______________________________________________________________________________

3. Relation with Student : ______________________________________________________________________________

4. How would you rate the student in the following characteristics ? (√ the appropriate)

6. What is the student’s class rank? : ____________________________________________________________________________

7. Some gifted individuals make mediocre scholastic records. Is the student’s record an accurate index of his/her capabilities?

Yes / No

If no, state why? : ______________________________________________________________________________

8. What is the student’s biggest weakness? : ______________________________________________________________________

9. Have there been any major changes in the student’s attitude towards studies till now at any time, if so illustrate, when and why?

(You may attach a blank page if required.)

10. Please mention any other information relating to the student, which help make FIITJEE understand the student better.

________________________________________________________________________________________________________

________________________________________________________________________________________________________

11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health

to successfully cope up & complete his/her studies at FIITJEE and fulfill all terms & conditions.

Father / Mother / Legal Guardian’s Signature

Date : _________________________________

Place : _________________________________

Excellent Good Average Below Average Low Unknown

Sincerity

Leadership

Imagination

Emotional stability

Ability to work with others

Ability to work hard

Perseverance

10

Enrollment Form

Annexure “B”

TERMS & CONDITIONS FOR POST DATED CHEQUE(S)

I understand that if my son/daughter/ward withdraws from the Program to which he/she has been admitted at any point of time or does not attend the Program and thus the seat given to him/her is rendered vacant, the same will not/can not be filled up by any other candidate and a vacancy created in the batch due to withdrawal of a student after the starting of classes or up to 2 days prior to the same cannot be filled in any case, therefore I understand that FIITJEE shall suffer irreparable losses in case of non-payment of remaining fee of the installment plan, hence it will be unethical not to honor the Post Dated Cheque(s).I have opted for installment fee plan and have submitted the Post Dated Cheque(s) as per the details give below.

I agree that, I will make arrangement, for below stated Post Dated Cheque(s), to get honored, and will keep sufficient funds on or before the due date for the same.

I further agree, to get above Post Dated Cheque(s) cleared, even if, my son/daughter/ward discontinues studies at FIITJEE, irrespective of any reasons.

I am signing the above declaration in good mental/physical health. I have satisfied myself about FIITJEE. The necessary Enrolment-Forms, including this form was received by me several days before the actual date of signing to enable me to understand the implications of taking admission at FIITJEE. I have taken expert opinion regarding matters which were not clear to me and I am satisfied.

Signature of the Student Father / Mother / Legal Guardian’s Signature

Name : ____________________________________________________ {Who has issued the cheque(s)}

Enrolment Number (for office use only) : __________________________ Name : ______________________________________

Date : _____________________________________________________ Address : ____________________________________

I have retained photocopy of this document for my reference before submitting it at FIITJEE.

Date : _________________________________ Father / Mother / Legal Guardian’s Signature

Place : _________________________________ Name : ______________________________________

Detail(s) of Post Dated Cheque(s)

S. No. Cheque No. Dated Issuing Bank Fee Amount S. Tax Amount Total Amount

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

Affix one self attested passport sized

photograph of the person issuing Post Dated

Cheque(s) i.e. parents / guardian

11

Enrollment Form

Annexure “C”

CONSEQUENCES OF DISHONOUR OF POST DATED CHEQUE(s)

I understand that non-clearance of any of the Post Dated Cheque(s), submitted for payment of fees (on installment basis) as mentioned

in the Enrolment-Form and annexure “B” is punishable under Sec. 138 (B) of the Negotiable Instrument Act. I understand that FIITJEE

shall be entitled to proceed and initiate appropriate legal action against me, to recover the amount of the Post Dated Cheque(s) along

with the legal expenses and out of pocket expenses incurred by FIITJEE.

In case any of my Post Dated Cheque(s) bounces for any reason whatsoever, I undertake to submit a DD/Pay-Order in favour of

“FIITJEE Ltd.” payable at New Delhi, within four days of the bouncing of the Cheque(s) at my bank, together with Rs. 500/- (Rupees

five hundred only) as default money alongwith late payment of Rs. 50/- (Rupees fifty only) per day upto 10(Ten) days from the due

date of payment of instalment after which my son/daughter/ward shall be debarred from classes without any further notice and I shall

have no claim for refund of fees or any support in studies besides Legal action inter alia action under Section 138 (B) of the Negotiable

Instrument Act may be initiated against me/us.


Name : ____________________________________________________ {Who has issued the cheque(s)}

Enrolment Number (for office use only) : __________________________ Name : ______________________________________

Date : _____________________________________________________ Address : ____________________________________

_____________________________________________

_____________________________________________


Date : _________________________________ Father/Mother/ Legal Guardian’s Signature

Place : _________________________________ Name : ______________________________________

12

Enrollment Form

Annexure “D”

Kindly do not take admission at FIITJEE if the clauses of the declaration on the enrolment form along with the

following amendment is not agreeable to you.

Name of the Student : _________________________________________________________________________________________

Name of the Father / Parent / Guardian: ___________________________________________________________________________

Residential address : ___________________________________________________________________________________________

Specifically Declaration 7 is being reproduced hereunder :

Declaration 7 : In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever

the reasons be, neither is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of

any other existing or prospective student.

Declaration :

I/We the Father/Mother/Legal Guardian and / or the student hereby severally and jointly declare that I / we have read and understood

all the clauses contained in the Declaration on the Enrolment Form together with the above amendment and agree to abide by them

without any reservation or ambiguity.

I/We further declare that the above named student is taking admission in the ____________________________________________

___________________________________________________(course opted for) having considered everything material and on his /

her own sweet will and with the permission of the Father/Mother/Legal Guardian without any coercion from any side.


Name : ____________________________________________________ Name : ________________________________________

Enrolment Number (for office use only) : __________________________ Address : _______________________________________

Date : _____________________________________________________ ________________________________________________


Date : _______________________________ Place : _____________________________ Father/Mother/ Legal Guardian’s Signature

For Office use only

Check list for the Accountant / Admission Coordinator.

v Name of the Accountant / Admission Coordinator.

v The Application form is complete in all respect with Annexure A,B,C and D duly signed by the student and the parent.

v The details of the scholarship offered.

o Cash scholarship (If any) : _______________________________________________________________________________

o Fee Waivers offered (If any) : ___________ % on ____________________________________________________ ground.

o Hostel fee waiver (If any) : ______________________________________________________________________________

v The certificates pertaining to scholarship are attached.

v 6 passport size and one stamp size photograph are attached.

v Late payment charges / Admin. charges duly calculated and collected.

v The fee charged has been duly matched and verified with the fee brochure.

v Signatures on PDCs and on Annexure B and C are same.

v Is the student joining as a Hosteller? If yes details of the Local guardian are provided.

v The student has been offered the admission after selection in Admission test only.

Declaration by the Accoutant / Admission Coordinator.

I have verified the entire enrollment form and checked all the points mentioned above. The Enrollment is recommended.

Date : _______________________ Place : _________________________ Signature of the Account / Admission Coordinator

Enrollment Form - FIITJEE Limited - For IIT-JEE, NTSE ...fiitjee.com/FTRE11res10Jan12/Enrollment...

Documents

Transcript of Enrollment Form - FIITJEE Limited - For IIT-JEE, NTSE ...fiitjee.com/FTRE11res10Jan12/Enrollment...