GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHlDIRECTORATE OF EDUCATION: SCHOOL BRANCH

OLD SECRETARIAT DELHI-1I0054

No.DE.2J(455)/Sch.Br./NGOW ?--",O Dated::5?- h ~CIRCULAR

Subjects- Regarding Outreach in Government Sponsored/afilliated schools in NewDelhi for "Fortunate 40"-a social initiative of FUTJEE to help & supporteconomically deprived students.

Please find enclosed herewith the proposal alongwith application form received fromMr./Ms. Partha Halder, Director-Academics FIITJEE Ltd on the above subject

All Head of Schools are directed to inform the students about the programme which isspecially meant for those students whose parental incomes is less than Rs. 1.20 lakh p.a. FliT JEEhas informed that 40 selected students (each of classes VIII & X) will be supported by them bymeans of classroom coaching for various entrance exams. Those who do not get selected as"Fortunate-40" can also avail themselves of these services at subsidized rates. Students will be atliberty to take the test at the nominated test centres with their parents.

This issues with the prior approval of competent authority.

Enel: As above. bv--rI>llb

DEO (School)

All Heads of Govt. Schools through DEL-E

No.DE.2J(455)1Sch.BLINGOM/ 2'10 Dated- $"J vII (,

Copy to:-I.PS to Secretary (Education)2.PS to Director (Education)3.AII DDEs/DEOs for necessary action.4.0S(IT) to please paste it on the website5.Guard File

~~\bOSD (School)

.' FIITJEEToThe Additional Director - SchoolsDirectorate of EducationOld Secretariat, Civil linesNew Delhi -110054

Date: 1" February, 2016

(Sub : Request for Outreach in Government sponsored/affiliated schools in New Delhi for"Fortunate 40" - a social initiative of FIITJEE to help & support economically deprived students)

Dear Sir/Ma'm,

Greetings from FIITJEE!!

We are pleased to introduce to you FIITJEE which is guided by the principle "To create world's bestfor Profit Education company and also world's best Not for Profit Institution that serve the societyfor thousands of years - may be perennially". With its long standing experience of 23 years, we atFIITJEE consciously work, every moment of the day, to ensure that every student fully unravelshis/her multidimensional talent and potential. Keeping this in view FIITJEE launched a scheme in2008 by the name "FORTUNATE -40" - which is a social responsibility (under its CSR commitment) tohelp and support economically deprived students.

FORTUNATE 40

Under this scheme 40 students each of Class VIII (going to class IX in 2016) & Class X (going to ClassXI in 2016) are supported by FIITJEE by means of classroom coaching and mentoring sessions -aiming for various scholastic & competitive exams like:

• JEE Advanced

• JEE Main• All Major State Level/Private Engineering Entrance Exam

• Class X & XII Board Exam• National Talent Search Examination (NTSE)• Kishore Vaigyanik Protsahan Yojana (KVPY)

• Senior Science Olympaid (Physics/Chemistry/Astronomy/lnformatics)• International Junior Science Olympiad (USO)

• Junior Science Talent Search Examination (JSTSE)

FIITJEElimited, 31-32-33 CentralMarket, West PunJabiBagh,New Delhi-110026. Phone- 011.45634004/05

FIITJEEKindly refer to the table below to understand the how a student is expected to set his/her goal andmilestone target and subsequently work towards it :

•NTSE

~ Clo-" VIII to XI

IOfPV > CI." XI & XII

Senlo,Sc,",,,,,,,Olympiad

> CI~-" XI & XII),.,,1...-Sci ••nce

Olym ••i~d

Senior SegmentStudents going to XI

The process flow to avail benefit under FORTUNATE -40 is mentioned below:

Middle SegmentStudents going to IX

• Students who are belonging to economically deprived background (ie household income lessthan 1.2Lakhs per annum) are eligible to apply.

• Once application is processed and accepted by FIITJEE, the student will have to appear for aselection test (scheduled on 7th February, 2016). The selection test is conducted across India at thesame date and time.

• The results will be declared on 17th February, 2016 (for students of Class VIII - going to ClassIX) & 19th February, 2016 (for students of Class X - going to Class XI).

• Selected students will be eligible to join FIITJEE classroom program and avail benefits underFortunate 40 (upto 100% scholarship on coaching). The general terms is listed in theenclosed Fortunate 40 brochure.

• Non - selected students under FORTUNATE - 40 but who has the potential to do well underproper guidance can join FIITJEE classroom program by paying some fee (which will be lessthan the actual fee - since substantial scholarship will be offered keeping in mind theirfinancial status). Though there will be no compulSion to join. The students and their parentswill be free to take a well informed & conscious decision on this.

FIITJEELimited, 31-32-33 Central Market, West Punjab: Bagh, New Delhi -110026. Phone - 011.45634004/05

FIITJEE• Enrolment will be offered on the following courses:

a. Class VIII (going to Class IX) - 4 year Classroom program covering all scholastic andcompetitive exams as listed in Page 1.

b. Class X (going to Class XI) - 2 year Classroom program covering all scholastic andcompetitive exams as listed in Page 1.

• The classes will be conducted at FIITJEE centres in Delhi. For location and address, kindlyrefer to Annexure 1. Students can select their preferred centre based on their convenience.

• The classeswill commence from new academic session ie April, 2016,

• The total selection under FORTUNATE - 40 is listed in the table below

location Total Maximum Selection

FIITJEE - South Delhi Class - VIII (going to Class IX) - 40 studentsClass - X (going to Class XI)- 40 students

FIITJEE - Punjab! Bagh Class - VIII (going to Class IX) - 40 studentsClass - X (going to Class XI) - 40 students

FIITJEE- Janakpuri Class - VIII (going to Class IX) - 40 studentsClass - X (going to Class XI) - 40 students

FIITJEE - Rohini (Kohat) Class - VIII (going to Class IX) -40 studentsClass - X (going to Class XI) - 40 students

FIITJEE - East Delhi Class - VIII (going to Class IX) - 40 studentsClass - X (going to Class XI) - 40 students

FIITJEE - Dwarka Class - VIII (going to Class IX) - 40 studentsClass - X (going to Class XI) - 40 students

Total Maximum Selection/Seats Available in Delhi-

Class VIII (going to Class IX) - 240

Class X (going to Class XI) - 240

FIITJEElimited, 31-32-33Central Market. West PunjabiBagh,New Delhi llOOZ6. Phone 011.45634004/05

FIITJEEInformation Related to FORTUNATE - 40 Selection Test

• Test Date - ]Ill February, 2016 (SUN DAY)

• Last date for application - 5th February, 2016

• Test will be conducted at FIITJEE nominated test centres. Please refer to Page No 3 of(Information Booklet enclosed)

• Application forms available from FIITJEEcentre at NO COST. The same can be distributed toschools as per request.

• Students will have to select preferred study centre and test centre at the time of filling up ofthe application form. (Please refer to centre code and test centre code in the Information

Booklet enclosed)

• At the time of filling up the application form certain basic documentation is mandatory.Guidelines are listed in a "Self Declaration Form" to filled and signed by the

parents/guardian of a student.

• For test timing - please refer to Page No 1 of FORTUNATE 40 (Brochure)

• For test syllabus- please refer to Page No 7 of FORTUNATE 40 (Brochure)

• For general terms and conditions - please refer to Page No 8 of FORTUNATE 40 (Brochure)

• The last date for enrolment and availing FORTUNATE 40 benefits will be notified to thestudents at the time declaration of results.

• Enclosed following documents for your reference:

a. Course Bookletb. Performance of our Students in various scholastic & competitive examc. FIITJEEclassroom program benefitsd. Reward booklet - If a student brings name and fame to the country at International

stage and/or if they secure top ranks they are entitled for rewards by FIITJEE.

In order to take this opportunity to large number of beneficiaries in Delhi, we wish to request andsought your kind support so that the information and benefits of FORTUNATE 40 could be madeavailable to all those students who are otherwise forced to quit their dream owing to financialconstraint.

We look forwa~~tG~Iii"ar:f-rQQ1.you. Thanking you in anticipation./ ,12.1= L/,~-,"",'\ ,,0,

f ...:: ' •.• -.:~I \Nest. \, r~,-, ..~ p..,"CIIIJ'~~?2..\ \. ~-l- .

P"~ alda'i' ,,~I",\",~., I ;:,-1(.>.1 7\,,' ''"' '.~: .•,

rue ctor-~~ emi~ :::;>:(1',1 .!'/ »:PI :. ,",\1'" /",FIITJEELtd 1-31;'3.?-~llentr91 Market, West Punjab! Bagh I New Delhi -110026E ..partho.haldar'@fi~'§"ib~

'-'-::-:--:-- --~

NB : All for communication and coordination we will nominate company representatives to ensure smoothcoordination. For the time being Mr. Samiran Datta, CEO (M:9910330466/E : samiran.datta@fiitjee.com)willbe coordinating with your office.

FIITJEELimited, 31-32-33 Central Market. WestPunjabi Bagh, New Delhi 110026. Phone 011.45634004/05

FIITJEEAnnexure - 1

FIITJEE centres in Delhi

Location Address

FIITJEE - South Delhi FIITJEE House, 29 - A, Kalu Sarai, Near Hauz Khas Metro Station,Sarvapriya vthar. New Delhi -110016

FIITJEE - Punjabi Bagh 31,32,33 Central Market, West Punjab! Bagh, New Delhi -110026

FIITJEE- Janakpuri 8-1, 623 2,,,1 Floor, At Distt Centre Crossing, Opp Metro Pillar No 574,Janak Puri, New Delhi -110058

FIITJEE - Rohini (Kohat) 367, Kohat Enclave, 2nd & 3rd Floor, Near Kohat Metro Station, Pitam Pur a,New Delhi - 110034

FIITJEE- East Delhi sth Floor, Roots Tower, Dtstt Centre, Laxrni Nagar (Near Nirman ViharMetro Station), New Delhi -110092

FIITJEE- Dwarka Plot No 47, (Opp Sal Bhawan International School), Sector -12B, Dwarka,New Delhi.

For complete details in terms of location, phone numbers etc, kindly refer to Page No 14 ofFortunate - 40 (Brochure) enclosed along with this letter.

FIITJEELimited, 31-32-33CentralMarket, West Punjab Bagh.New Delhi -110026. Phone 011.45634004/05

FIITJEE

Information Booklet~, ~~~_w=-,,~,,_,~.__ ·~~·_, ~#

FORTUNATE 40A Social Initiative by FIITJEEto Help the Economically Deprived

Your dream will not just be a dream!Breaking Financial Barriers, FIITJEEpromises to help you realise your dream.

Selection Test: Sunday 7th February, 2016

For Students presently in

Class VIII (soon going to Class IX) i.e. Aspirants of JEEAdvanced, 2020 and

ClassX (soon going to ClassXI) i.e. Aspirants of JEEAdvanced, 2018

A Program to provide worfd-Ctass training to serious Students from financially weaker backgroundsto achieve their goal of Success & Top Ranks in JEE Advanced and Other Competitive Exams.

Eligibility For Students presently in Class VIII (soon going to Class IX) i.e. Aspirants of JEEAdvanced, 2020and

For Students presently in Class X (soon going to dass XI) i.e. Aspirants of JEE Advanced, 2018

Student should be from Central Government School, State Government School for under privileged section of satiety for example students

studying in Navodaya Vidyalaya Samiti Schools. The total parental income should be less than Rs. 10,OCIOf- per month.

Other students (studying in public f private schools) may also apply, however their application will be considered on case to case basis and on

the discretion of the management.

Last Date to Register Thursday, 4th February, 2016

Result Declaration Dates For Students presently in Class VIII (soon going to Class IX): Wednesday, 17th February 2016

For Students presently in Class X (soon going to Class XI) Friday, 19th February 2016

Results will be Available at www.fiitjee.comandwww.fiitjee.wm/f40.htm

How to Register

Fill in your complete details in the Application Form mentioning test centre, segment code and preference of study centre alongwith:

(a) Self Declaration Form (of parental income)

(b) Two passport size colour photographs and submit it to the nearest FlITJEE centre.

Registration is OPEN at all FIITJEE Centres. (for complete list of FIITJEEcentres, see page no. 14 to 16 of Fortunate - 40 Brochure)

Documents Required to be submitted at the time of Admission:

Selected Students will have to submit the following documents at the time of taking admission:

1. Marksheet of last class attended

2. Certificates of scholastic achievements (if any)

3. Residence proof (Ration card / Aadhaar Card I Passport / Election Id Card of parents)

4. Income proof of parents (Father & Mother) as given below:

(a) Salary Slip of last month (if employed in a private firm / Government I Semi Government organisations)

(b) Affidavit f self declaration form (as per requisite format) duly attested by anyone of the following - District Police Chief (City

Chief in case of Metro), General Manager or above rank of Nationalised Bank, District Income Tax Chief (City Chief in case of Metro) I Assistant

Commissioner & Above Rank. In case you are not able to get desired co-operation from these officials you may then approach Chief Minister,

Home Minister or Education Minister for the State, Minister of Home, Minister of Foreign Affairs, Minister of Education at the Centre, Supreme

Court & High Court Judge, Cabinet Secretary, Home Secretary, Foreign Secretary, Education Secretary at the Centre or even Honorable

President or Prime Minister.

Fee for Selection Test Nil

Test Schedule & Pattern

For Students presentlv in C/ou VIII (soon going to C/au/X)Paper 1(3 hours) Objective Type Questions to gauge current level of preparedness

(10, Science & Mathematics) 9:00 am . 12:30 prn

Paper 2 (3 hours) Objective Type Questions to test Goal oriented Analytical Skills

(Physics, Chemistry & Mathematics) 1:30 pm - 4:45 pm

For Students Pfesently in Class X (soon going to Class XI)

Paper 1 (3 hours) Objective Type Questions to gauge current level of preparedness(10, Physics, Chemistry & Mathematics) 9:00 am - 12:30 pm

Paper 2 (3 hours) Objective Type Questions to test Goal oriented Analytical Skills

(Physics, Chemistry & Mathematics) 1:30 pm - 4:45 pm

Note: The time period of 9:00 am to 9:30 am & 1:30 pm to 1:4S pm is for filling up the information on the OMR Answer Sheet and forreading the examination instructions. For information on how to fill up Answer OMR Sheet, please download" An Introduction onOMR Sheets" from www.fiitjee.com/fillomr.pdf

Details of Segment, Registration Centres, Study Centres & Test Centres with CODES

1. Segment & Segment Codes {to be filled in point no 2 (c) of the Application Form]:

Segment Segment Code

Fortunate - 40 Test for Students presently in Class VIII (Going to class IX) 9004

Fortunate - 40 Test for Students presently in Class X (Going to class XI) 1104

2

2 Registration Centre I Study Centre Codes {to be filled in Point No 2 (b) & 2 (d) of Bar-coded Application Form}'

t. AV<lilable as Available as

,/ CENTRE CODE ~I~ CENTRE CODECentre 1 Study CentreRegistr<ltion Centre Study Centre Registration

Delhi (South) 11 " " Hvderabad (Saifabad) " " I "Delhi [Punjab! Bagh) T ia T " " Indore 48 " "Delhi (East) I 13 " " Jatpur (J,L.N Marg) rr I " "Delhi (Janak Puri) 14 " " Jaipur (Vaishali) 32 " "IDelhi (Rohirli) " " " Jaipur (Vidhyadhar N<3g<3r) 28 " "Delhi (Dwarka) 10 " " Kanpur 14 " "Delhi NCR (Gurgaon) 18 I " " Kochi 65 " "Delhi NCR (Earidabad) 19 " " Kclkata [Rabmdra Sadan) I n " "Delhi NCR (Ghaziabad) 20 " " Kolkata (Ultadanga-Salt Lake) I rr " "Delhi NCR (Noida) 21 " " Lucknow I 22 " "Allahabad 29 " " Meerut 06 " "Amritsar 17 " " Mumbai (Andheri) 42 " "Bangalore " " " Mumbai (Chembur) 43 " "Bhilai 46 " " Mumbai (Kandivali) 44 " "Bhopal 47 " " Mumbai (Novi Mumbai) " " "Bhubaneswar 73 " " Mumbai (Thane] 40 " "Bokaro 83 " " Nagpur as " "Chandigarh is " " patna 81 " "Chenn~i (Ady~r) 62 " " Pune 39 " "Chennai (Kilpauk) 61 " " Raipur 38 " "Chennai (KK Nagar) 69 " " Ranch! (Lalpur) 82 " "Chennai (Sriperumbudur) 63 " " Ranch! (S.D.P) 85 " "Coimbatore 64 " " Rourkela 76 " "Dhanbad 84 " " Shaktinagar (NTPC) za " "Durgapur " " " vadodara 33 " "Gwalior sa " " Varanast 25 " "Gorakhpur 92 " " vijevawacc 58 " "Hyderabad (Dilsukhnagar) 52 " " Vtsakhapatnam 54 " "Hvderabad (Kukatpally) 03 " "3 Test Centre Codes {to be filled in Point No 2 (e) of Bar-coded Application Form]:

Test CentreTest Centres

Code

290 Allahabad - FIITJEE Ltd, 9 A, Edmonston Road, Opp. NIP, Civil Lines

170 Amritsar - FIITJEE Ltd., 3rd Floor, SCO - 31, District Shopping Centre, a-arock, Ranjit Avenue

550 Barlgalore - FIITJH Ltd" 113/114, 3rd Floor. HTR Ch~mber" S.C, Rd, Opp. HOY,Jla Hotel, Seshadrlpuram

648 Bangalore - FIITJEE Ltd" 11'19,S S Plaza, 13th Cross, Sth Sector, Outer Ring Road, HSR Layout

551 Bangalore - Saint Joseph lndlan High School, Near Mallya Hospital. Vittal Mallva Road

462 Bhilai - MGM S~hool, Sector - 6

470 Bhopal- FIITJEE Ltd" Plot No 102, Back Lane of City Hospital, Zone II, M.P. Nagar

730 anueeneswer - FIITJEE Ltd" Bharat Scouts & Guides Complex, Scouts Bhawan, 2nd Floor, C- IX / 8, Unit - 3, Bhubaneswar

822 Bhubaneswar - kasturtba Shlkshvashar arn. Plot No: 695, Opp. Nebar d, Navapalli

848 Bok~ro - Sardar Patel Public School, Sec-9/A, BRoad Bokaro Steel City

162 Chandigarh - Shivallk Public School, Sector 41

623 Cherlrlai (Adyar) - Kumararani Meena Muthaih Mat Hr. Sec School, Gandhi Nagar, Adyar

611 Chennai {KilpaukJ - Maharishi vrcve Mandir Senior. Secondary. School, No. 28, Dr. Gursamy Road. Chetpet

613 Chenrlai {Sriperumbudurj - Maharishi International Residential School, Santh<3velur, Sunguvar Chathlram

637 Cherlrla; Ivetasaravakkamj - Devi Academy Senior Secondary School, Plot No, l/E-l, Door No.7, Alapakkarn Road

676 Coimb<ltore - Hindusthan College Of Arts And Science Hlndusthan Gardens. (Behind Nava India), Avanasht Road

351 Cuttack - xeuesf Plaza, 3rd Floor, Opp. BSNL 8hawan, Link Road, Cuttack

108 Delhi (Dwarka) - Adar,h World School, Sec 12, Dwarka

131 Delhi (East) - Lovely Public Senior Secondry School, Priyadarshini Vihar

140 Delhi (Purljabi aagh) - FIITJEE Ltd, B-1, 623, 2nd Floor, At District Centre Crossing, Janakpuri

125 Delhi (Purlj<lbi a<lgh) - M.M, Public S~hool, vasudha Enclave, Pitampura

103 Delhi (South) - Lal Bahadur Shastri JAVM Sr. Secondary School. sector-a. R,K, Puram

199 Delhi NCR (Faridabad) - Gita Convent School, Sector 16, Faridabad

200 Delhi NCR (Ghaziabad) - FIITJEE Ltd" Inspiration Plaza, Plot 0-6 & 7, Raj Nagar District Centre (RDC)

304 Delhi NCR (Greater Noida) - Pragvan School, Sector-Gamma-I,Greater Nelda

3

-Test Centre Test Centr

Code , ," "182 Deihl NCR (Gurgaon) - Blue Bells Model School, Sector-"---.

211 Delhi NCR {Noida}- Lord Mahavira School, Sector - 29, Naida

840 Dhanbad - FIITJEE Ltd., Tara Apartment, Plot No 2311-2313, Moma Saraidhela,

740 Durg~pur - FIITJEEltd., A·3, Nandalal 6ithi, City Centre

92O Gorakhpur - FIITJEELtd" Araji, No 18, Prabha Complex, Main Kasva Road

930 I Gwalior - FIITJEELtd_. Rama Plaza, 12-C, Kailash Vihar, City Centre

520 I Hyderabad (DiI5ukhnag~r) - FIITJEELtd" D,No .. 16-11-477/612/2, Opp: S~shi Ho

530 Hyderabad (Kukatpally) - FIITJEELtd., H.No.12-97, Plot No.1, Opp Pat~unta

510 Hyderabad (Saifabad)- FIITJEELtd., U 5·9-14/6, Opp. Secretariat

~80 Indore - FIITJEELtd., 27, 2nd Floor, Scheme 54, Opp. Orbit Mall, PU-3 Cornmenc

270 iJ3ipu~- FliTJEE JLN Campus- 3 AI D.LTower, J.L.N. Marg, Jaipur

320 Jaipur - fllTJEE Ltd., First Floor, C-1 C Block, Vaibhav Multiplex. Amrilpa~ircle,

m Jaipur - fllTJEE ltd., vfovadhar Nagar, 302, 3rd Floor, Times Square, Central Spi

240 Kanpur - FIITJEELtd" 16/116 Karmin Arcade, Civil Lines - ._-----

,Dhanbad

spital

Huda Park, vuavnager

al Bhamori, AB Road

vetshan Nagarne. Vidyadhar Nagar

664 Kochl - Saraswathl Vldy;lnlketh~n P~b~c School, Peranoccr Road, Elama~.~aril. Kochi

711 I Kolkata -J.1. Ajmera School. 12B Hetshvam Road356 I K Ik t {Ult d ) Sl F X S h I GA Block Purbanchal Phase I Sector III Salt Lake Cityo •• an anga - rancrs avrer C 00,

220 Lucknow - FIITJEELtd .. The S(holars Home School. vipul Khand - 3, Gomti Nagar

248 Lucknow -M.G. Convent School. Sector - G, l.DA Colony. xenour Road, Near Power House Chauraha, Aashiana

600 Meerut - FIITJEELtd.. Property No 80 Behind, Sales Tax Office, Mangal Pandey Nagar, University Road

420 Mumbai {Andheri) - FIITJEELtd" Baba House, Ground Floor, Andheri curta Road, Off Western Express High Way. Andhe!i East

430 I Mumbai {Chembur) - FIITJEEuo.; Ujagar Complex, Opp. oeoner Bus Depot, Off Sian Trombay Road, Deonar. Chembur

440 MumbaiJKandiveli) - FIITJEELtd." T~akur Vidya Mandir, Thakur Complex. Kilndivali {EI

450 Mumbai [Navl Mumbai) - FIITJEELtd.., 8-500, 2nd Floor, Vashi Plaza, Plot No 80-81. Sector-17. Navi Mumbai

400 Mumbai {Thane) - FIITJEELtd, Evershine Mall, 2nd Floor, Shivaji Path. Opp M.H. ~igh School. Near Station Road, Thane [West)

817 MutaHarpur - North Point Childrens High School. Sherpur Road, Mithanpura Chowk, P,0, Ramna

490 Nagpur· FIITJEETower, 210, Opp. Children's Traffic Park, Oh~rampe_'_h__-

492 Nagpur - Science Club, Raut Wadi, Akola- - ------760 patna - patna St. Michaels School, Ashok NJgJr Road No-3, Near Dwarka College Kankarbagh

- ~814 P~tna - Model St. Michel High School, Dujar a, Buddha Colony

--- -339 Pune - Bharati Vidyapeeth English School. OpP. Balewadi Sports Complex. Near MOle Engineering (oll~ge, Balewadl

390 Pune - FIITJH Ltd., 3rd Floor, Vega (entre, Swargale, Shankar-sheth Road, Gultekadi, Pune

380 Raipur - Shankar Nagar Vidya Mandir School, Near vrovc Hospital, Shankar NagarI989 Ranchi - Ranchi - st. Aloysius School, Purulia Road ~

230 Shaktinagar_NTPC - FiiTJEELtd" Employee Development centre, Hostel NO.-3, NTPC, Dist. Sonebhadra 1911 Vadodara - Alembic Vidyalaya. Gorwa Road Vadodaro-- ~250 Varanasi - FIITJEELtd.. B-38/1K. Mahmoorganj. Varanasi

580 Vijayawada - FIITJEELimited, 38-8-45.{Pas>port Office Building), Opp.Alllndia Radio Station, M,G Road

568 Visakhapatnam - FIITJEEltd. {Extn,I, Plot No. 30-C, 5th Lane, Dwarakilnagar, Visakhapatnam

Terms & Conditions of FORTUNATE 40 (2016)

1. Fee Waivers for FIITJEEPrograms and Hostel Fee Waivers will be decided on the ba5i~of combined performance in both Paper 1 & Paper 2, Performance in Paper 2will be considered only for those Stude~ts who qualify (i.e. clear minimum cut-off marks) in Paper 1. Students must appear in both the Papers i.e, Paper 1 & Paper 2to become eligible for any Program Fee Waivers I Hostel Fee waivers

2 The final discretion of awarding the fee waivers far FIITJEEprograms & hostel fee waivers in each cas~ will remain with FIITJEEmilnagement and thi~ decision willbe final and binding on the (andid"te.

3, Fee waivers for FIITJH programs & Hostel Fee Woivers are vdlid lor the ~ele(t mentioned programs only. Students enrolling with benefits (Scholarship for fllTJEEProgram I Hostel Fee Waiver) associated with Fortunate 40 selection test. cannot join anv other institute in any form. In case the Student joins another institute. allthe benefits given will be withdrawn and FIITJEEcan also take action against such ShJcient

4. Hostel fee co"ces~io", Iii ~ny) ~re valid only lor FIITJH's associate hostels I lodging & boording facilities (wherever available & for mole Students only) madeavailable through fllTJEE, subj~ct ta the Student joining that particular hostel and availability of seats. The concessio~ will be given monthly betwee~ April. 2016 toMarch, 2020 for joining Four Year Classroom II~tegrated School Program for JEEAdvo~ced, 2020 OR between April, 2016 to March, 2018 for joining Two Yearintegr"ted School / CIJssroom Program lor JEEAdva~ced, 2018 and only for the duration of Integrated School I Classroom program. The Hostel fee concessions (ilany) are valid lor the above mentioned progroms only, The hostel fee con(essions {if a~y) will b~ p,,;d directly to the hostel owner by FIITJEE,Hostel feeccncesstcns lif any) is for a<commodation only. Food, transportation & other self upenses are to be borne by the Student •. To avail this concession, Student,must have Optimum Periorman<e in Phase Tests & National level Tests and a mi~imum of 90% monthly attendance in their respective Classes at FIITJEE.Hostelfacility is available at ,ele<t FIITJEECentre~ only.

S. FIITJEEreserves the right to change I cancel Jny program, eligibility criterion without prior notice1) (0). The registered office 01 FIITJEELimited i~ at New Delhi, All di,pute, ond differe~ces 01 any nature with regard to the Fortunate 40, subsequent enrollment and

,tudic, ,hall b~ r~ferr~d to the Sole Arbitrator appointed by the Monagement of fllTJEELtd. The Arbitration proceedings shall be condu(ted in accordance with theprovisions of the Arbitrotion and Conciliation Act 1996 and Statutory modification thereof ond rules r]lade there under. The award of the arbitrator ,hall be final &binding, The arbitrator so appointed sh,,11nol he inc~pacit"tcd for rea,ons of their being the employee of FIITJEELtd, or it, si,ter concern. and for reasons of havingany prior linkJge wilh the (ompuny. The ,eat of arbitration will be Delhi, All the parties - Student I parents I guardian & FIITJEEagree that they shall not commen.;eor maintain any action in o caurt of law relating to Fortunate 40, subsequent enrollment & studi~s "t FIITJEEe.cept for enforcement 01 the arbitral award, Allparties waive any right ta appeal, Thi, i, needed for 'reeciy reJ,e,Sol of issue, & all parties agree to this,

(bl. Subject to 1)(il) herein obove, the exclusive Jurisdiction in the matter shall vest in DelhiI New Delhi Courts only,

Note: All FIITjEE Scholarships orr 3rd Party F~nded based on Grams and Donations rereived from various Philanthropic Trusts & Societies.

National Admissions Office: FIITJEE House, 29-A, Kalu Sarai, Sarvapnva vrhar. New Delhi -110016Ph: 011-49283471/73/75 All India Toll Free No.: 1800 114242 E-mail: info@fiitjee.com Web: www.fiitjee.com

4

Self Declaration Form

of Total Parental Income

for Students registering to appear in

•• FORTUNATE 40 Selection Test on 7th February, 2016

We ........ ................ (Father) & . ............ ...... . ....... (Mother),

the parents of ...... ... ......... ..................... (Name of Student) who

will be appearing in Fortunate - 40 Selection Test to be held on 7th February, 2016, hereby declares

that our joint income is Rs . (In words Rupees ........................................................... )

per month.

If at any stage, it is found that the above information given by us is false I not true, all the benefits givento our ward, attached with Fortunate - 40 Selection Test to be held on 7th February, 2016, will bewithdrawn and legal action as deemed fit, may be taken against us and our ward.

Documents Required' Selected students will have to submit the following documents at the time of(AII/Je time of Admission) taking admission

I 1. Marksheet of last class attended

I 2. Certificates of scholastic achievements (if any)3. Residence proof (Ration card I Aadhaar Card I Passport I Election Id Card

of parents)4. Income proof of parents (Father & Mother) as given below:(a). Salary Slip of last month (if employed in a private firm I Government I

Semi Government organisations)(b). Affidavit I self declaration form (as per requisite format) duly attested by

anyone of the following - District Police Chief (City Chief in case of

IMetro), General Manager or above rank of Nationalised Bank, DistrictIncome Tax Chief (City Chief in case of Metro) I Assistant Commissioner& Above Rank. In case you are not able to get desired co-operation from

I these officials you may then approach Chief Minister, Home Minister orEducation Minister for the State, Minister of Home, Minister of Foreign

IAffairs, Minister of Education at the Centre, Supreme Court & High CourtJudge, Cabinet Secretary, Home Secretary, Foreign Secretary, Education,Secretary at the Centre or even Honorable President or Prime Minister.

We have received & read the Tenns & Conditions printed in the Information Booklet & Brochure ofFORTUNATE 40 to be held on 7th February, 2016 & agree to abide by the same.

Date:(Name of Father) (Signature of Father)

Place:(Name of Mother) (Signature of Mother)

Mobile No.:

I(Father) (Mother)

Registration No. of Student:(for Official use only)

==-=-FIITJEE

APPLICATION FORM

(for Official use only)ReglslretionNo.Allolled: _

FormChed<edby: EmployeeCode: _ Signature Date'

Please fill this Form with a Black I Blue pen in BLOCK Letters only Apphcation Form No. F ~ 19 5 3 5Are you already Enrolled I Registered in FliT JEE ? IIyes. please provide the following info below

a] Enrollment Number

b) Students ID

Registration Number

__ Mobile Number

b) Date of Birth _ (DD/MMIYYYY) (e) Gender (.r) Male Female

(DO NOT STAPLI::.)

1. Details about the Student:

a) Name 01 the Student __

c) Last Annual Exam IBoard Exam Aggregate Marks (%) (f) Nationality

d) Stream you will pursue after Class XII {Please tick (./ I}

Engineering [ JNon·Engineenng: Humanities

pnctoq- rph f r Ha I I k

Fundamental Science ~ Commerce Medical L-J If other, plene specify

2. ueteus to be fitted in {for Registration Centre. Study Centre. Test Centre & Segment Codes. please refer to POint no 1 2 & J )f relevantInformation Booklet):

(a) Test Date

(c) Segment Code

(b) Reqrstranon Centre Code

(d) Study Centre Code L(e) Test Centre Code

1ft ~• (10, Clns 5//, fill 05, Class 6!h fill 00, Clus 7th fill OT, Class Ith fill 01, Clns 9th fiN OSI, Class 10th fill 10. Clus Il1h IiI/H, Class 12th fi/I 12 & Class 12th Pass lil/ll)

Class' Presently Studying In the Current Acsoermc Year (AY)

(g) How do you want to receive the Hall Ticket '------'E-Mail Prmted

(Printed Hall rlClcets will be Issued only if fhls Application Form Is submitted to. FIITJEE office in pel'SOn.,

J. Communication Details:

(8) E·MailIDs and Mobile Nos.

Student

E-Mail tD (Please Fill In BLOCK Leiters Only) MObil. Number

Father

Mother

Whal is yourpreferrede-mail ID Student Father Mother What IS yourpreferredMOblteNo. St~dent Father L.. Mother

(b) Correspondence Address: (c) Permanent Address: (Pleese men/ron only" differenl fromCorrespondence Address)

(Pleese do nol wnle 'lour (your Fe(he,'s name in eese addross boKes Fill/he eoaress only will •••, (hll spacli proVided in boxeS.)

4. Details about the SChool Presently Studying in/ Last Attended:

(a) School Name & Address

C!ly I Town

Pin Code State Tel No

(b) Board (SchOOlS affiliated to) {e} Your Current I Last Class Rank In your scncor

(d) Name of your School Principat

(e) Name of your Subject Teacher Mathematics Physics

Biology Chemistry

--=-=-=- ----=-==-

-ee ::: :::- -=-= =-S. Details about Parents (in BLOCK Letters only)

Father's ILegal Guardian Name __

Qualification Occupation _ Desiqnation ~_

Office Name I Address

ContactNos _

Mother's Name

Qualification ____ Occupation Oesiqnauon

Office Name I Address

___ Contact Nos

6. Oelails of your Scholastic Achievements in any of Ihese exams (Please tick (,t') & give its details))

NTSE ~ JSTSE NSEJS MTSE,--------, KVPY Olympiads C ~SATU

Oetails_

7_ Are you taking any specialized Coaching for Competitive Exams (Please tick( •.•..)} y~ No Since (Year)

If Yes, Name of your Coaching Institute

Your Overall Rank m your Coaching Institute _

8. Details about Your Sibling:

Name 1 (Brother I Sister)

Name 2 (Brother f Sister)

Class presenlly studying In

Class presently studying In _

9. How did you come to know about FIITJEE Programs? {Please tick("",}}:

Newspaper Advt. Social Media News Paper Insert Banner! Poster Website E- Mailer

Hoardings Radio Present! Ex- FIITJEE Student Friends IRelatives Through FIITJEE Faculty

if other source (please SpeCify)

Declaration by the Student IParent f Guardian

• I'we have received 8.read the Terms 8.Concrnons printed in the Informal ion booklet of the Test Dale mentioned against Point No 2 (a)ofthisApphcation Form and promisa toabIde by the same

• I have also cross verified the COdes filled in above Point 2 and I understand if an error occurs in tho recrstrancn due to wrong codes it will not be corrected by FliT JEE

• Tesl Dale, Test ceeue ccoe. Program Code etc. cannot be Changedoncereglstered.

• RegoSlri1lion Fee will nol be refunded In any case of transferred to any ceer Admission Test Date

• Iau1honze FliT JEE to contact and send commurllCallon/,nformation by $MS, e-ma~. poston 1he above men1ioned communication detallsglwn by me

• tn case a stccem reappears III FliT JEE rest. hIS' her scholarshIp (if awarded} will be scaled down by one slab so that he, she does nol haw any undue advantage over freshappearing Sludents

• FliT JEE reserves the right to offer study centre other Ihan the one opted by student. subject to availability! constraints of seats.

• Once students is granted admission to the hostel, he will not be permitted to withdraw during the course of the ecadornic session and not refund will be made during rmc-session

• Once a student JOInsthe study centre offered (Irrespechve of his I her choICe of study centre opted before JOining). no request for Change of sludy centre WIll be enterteoec. northe course fee paid WI" be refunded under any cm::umstances

• FnT JEE reserves !he righl to change Icancel any Program. Tesl Dale. Test Centre. Study Centre. el.g,blhty crnenon 8. CotJrse Fee wrthouI pnor notice.

• The Reglslered OffICe of FliT JEE llm~ed IS at New Dethl. In case of dIspute. students I parents are subject 10 the exclusrve Junsdidion of appropriate courts In DeIhl f NewDeihl only All dlspo;ted shall be referred to the Sole Atbl!ralor apPOInted by the Management of FliT JEE limited The decision of the ermtraior shall be final & binding Thearbitrator so apPOInted shall not be incapaCitated for reasons of their beIng the employee of FliT JEE lImited or its sister concern and for reasons of having any prior linkagewhhtne company

Fee Pard as. In Cash f DD I Pay Order No.· __ ueteo Bank

II we hereby declare thai the mrcrmauon furnished on this Application Form is COfTe<:\ [0 the best of my knowledge and belief.

Date:(Signlltufll of Student) (Name of Student)

Place:(Name of Parent I Guardian)(Signature of Parent I Guardian)

National Admissions Office: FliT JEE House, 29-A, Kalu Sarai, Sarvapriya Vihar. New Delhi - 110016.Ph.: 011-49283471173175 All India Toll Free No.: 1800 11 4242 Web: www.fiitjee.com

=-=-=- -::::.-::::.=

--------.••...•.-

FIITJEEAPPLICATION FORM

Please fill this Form with a Black I Blue pen in BLOCK letters only Application Form No. F ----1034784

(for Offici.t use only)Registrntion No AIIottecI: _

Form Checked by: Employee Code: Sognaturu: Date:

Are you already Enrolled I Registered in FIITJEE 7 If yes, please provide the following info below:

a) Enrollment Number Registration Number _

b} Students 10 Mobile Number _

(r) Nationality __

(00 NOT STAPLE)

1. Details about the Student:

a) Name of the Student _

b) Date alBirth (DDIMMIYYYY) Ie} Gender (.r) Male D Female 0Paste your

recent passport size

color photograph here

c) last Annual Exam I Board Exam Aggregate Marks (%) _

d) Stream you will pursue after Class XII {Please tick (y"')}:

Engineering ~

Non-Engineering: Humanities D

Carry one aoornonat

photograph for Hall Ticket

Fundamental Science D Commerce MedicaiD II other, please speclfy _

2. Details to be filled in (for RegIstration Centre. Study Centre, Test Centre & Segment Codes, please refer to point no. 1, 2 & 3 of relevantInformation Booklet):

(.) Test Date DC =r:J ITI::= (b) Reqrstration Centre Code ~~(c) Segment Code =:JCC= (d) Study Centre Code '--"(e) Test Centre Code DL.,(I) cress: Presently Studying in the Current Academic Year (AY) DO

• (fo. Clus 5fh fill 1)5,CI;>ss61h fill1)6,CI.u 71hfill07, Clus Blh fill06. Clus Ihh fill tit. C/us 1Chh fill Ia. Cia" 11th ml11, C/us 12th ml 12& Ct..ss 12th Pus mill).

(g) How do you want to receive the Hall Ticket [J E-Mail ~ Printed

(Printed Hall Tickets will be Issued only If this Application Form Is submltflld fO a FIITJEE offlce in person.)

3. Communication Details:

(a) E-Mail IDs and Mobile Nos.

Studellt

E_Mail10 (Please FiII;1l BLOCK Letters Only), _ Mobile Number

father

What ISyour preferred e-mail10 0 Student Cfather -' Motller

Mother

What ISyour preferredMobileNo. 0Student ~ Father 0Malhe.

(b) Correspondence Address: (c) Permanent Address: (Please mention oo1y ff different fromCorrespondenre Address)

(Please do not write your /your Fa/her's name In these address ecses. Fill the address only WIth,,, the space protIIded in boJ(es.)------ '\ r

l -------------~:===========:p:'"~====== _-- -Pin _

--------------------------/4. Details about the School Presently Studying in I Last Attended:

(a) Scncot Name & Address

__ City ITown

-- Pin Code Stale _ Tel. No.

(b) Board (School is affiliated to) (c) Your Current I Last Class Rank in your School

(d) Name of your School Principal

(e) Name 01your Subject Teacher: Mathematics _ Physics

Biology Chemistry _

---~-~

----...,:;;;;--~-- -•....• -5 Details about Parents (in BLOCK Letters only)

Father's I Legal Guardian Name ~~~_

Qualification ~~~~~~~~~~_ Occupancn _

Office Name I Address

ContactNos_~~~~~~~~~~~~~~~~~~~~~_

Mother's Name _

Qualification Occupation _ Designation

Office Name I Address

___ Contact Nos

6. Details of your Scholastic AChievements in any of these exams {Please tick (.I') & give ils details)}:

NTSE JSTSE NSEJSLJ MTSE KVPY --,--' Olympiads SAT ::J Others =:JDetails

7. Are you taking any specialized Coaching for Competitive EXCIms (Please tick( •••.)} No ~ Since (Year)

If Yes, Name of your Coaching Institute

Your Overall Rank in your Coaching Institute ~~~~~~

8. Details about Your Sibling:

Name 1 (Brother I Sisler)

Name 2 (Brother I Sisler)

Class presently studying in

Class presently studying in

9 How did you come to know about FliT JEE Programs? (Please tick(,,)}

Newspaper Advt. Social Media News Paper Insert Banner J Poster Website E- Mailer

Hoardings Radio Present' Ex- FliT JEE Student Friends , Relatives Through FliT JEE Faculty

if other source (pleasespecify),~~~_

Declaration by the Student IParenti Guardian

• II we ilave received & read the Terms & Conditions printed in the information booklet of the Test Date mentioned agai~st Point NO.2 (a) of this Application Form and promise 10abide by the same

• I have also cross verified the Codes lilled in above Paint 2 and I understand if an error occurs In the registmtlon due to wronq codes it will not be corrected by FliT JEE.

• Test Dale. resrcerure Code, Program Code etc. cannot be changed oocereeetereo.

• RegIstratIon Fee will not be refunded In any case Oltransferred to aJlYother AdmISSion Test Date

• I authonze FtlT JEE to contact and send commumceuce r IIll0rmation by SMS, e-mail, post on the above mentioned oommulllcat.oon details gIven by me

• In case a student reappears Ir\ FliT JEE Test. his I her scholarshIp (If awarded) will be scaled down by one slab SOthat he I she ooes not have any undue advantage OIIef freshappeamlQstudents

• FliT JEE reserves the nght to oHer study centre other Il\anlhe one opted by 51udem, subject to avaIlabilIty Iconstraims 01seats.

• Once students IS granted adm,ss.on to the hostel. he will not be permItted to WIthdraw dunng the course of the eceeermc session and not refund WIll be made dunng mld-session

• Once a student JOInsthe study centre oltered (IrTespective 01hiS I her enoree 01study centre opted before joining), no request lor change 01study centre will be entertained, northe course tee paid WIll be relunded under anyc"cum6t~nces.

• FliT JEE reserves the right to change I cancel any Program, Test Date. Test Centre, Study Centre. eligibility cntencn & Course Fee without prior notice.

• The Registered Office of FliT JEE LImited is at New Delhi. In case 01dispute, students I parents are subject to the exclusive junsdiction 01appropriate courts In Delhi I NewDeihl only All dIsputed snerce rererred to the Sole ArbItrator appcmree by the Management of FIITJEE LImited The cececn of the arbItrator shall be final & bindIng Thearbitrator soappo;nted snau not be jncapacrtaled lor reasons of their being the employee 01FItT JEE LImIted or ItS Slste, concern and for reasons 01haVIng any prior linkageWlltllhe company

Fee Paid as. III Cash I 00' Pay Order No.: Dated Bank

II we hereby declare that the mfcrrnation tunushec on this Application Form IS correct to the best of my knowledge and belief.

Date:(Name of Student)(Signature of Student)

Place:(Signature of ParentI Guardian) (N.me of ParentI Guardian)

National Admissions Office: FliT JEE House, 29-A, Kalu sera. Sarvapnya vmar. New Deihl - 110016.Ph .. 011-49283471173 f75 All lndta Toll Free No.: 1800 11 4242 Web: WHW.m~ee.com