APPLICATION FORM FOR BOOK GRANT

Name of the Student :___________________________________________________________________________

FIITJEE Enrolment No. ____________________Batch No. ______________Year of studying _________________

AIR No._______________in IIT-JEE held in ________________________.
IIT where currently studying_______________________Entry No.________________Branch__________________
Semester for which Book Grant is claimed _____________________Amount_______________________________
I have purchased the following books for the semester for which necessary receipts are enclosed and I am
submitting this application form duly certified by the professors.
Sl.
No.

Name of the Book

Price

Name of the Teacher/Professor

Certified that the Books are

prescribed by me (Signature of the
Teacher/Professor)

Mathematics
1
2
3
4
Physics
1
2
3
4
Chemistry
1
2
3
4
Total :-

Dated :______________

STAMP OF IIT

Permanent Residential Address (in Capital letters) : -

Signature of the Student

Name :- _________________________

________________________________________

Address

________________________________________

________________________________

( in Capital Letters) : -

________________________________________

________________________________

E-mail ID:________________________________

________________________________

Phone & Fax (with STD code)________________

________________________________

In case of change in information, please inform us or email at info@fiitjee.com

In case cheque is to be sent at location other than Permanent Residential Address
----------------------------------------------------------------------------------------------------------------------------------------------------------FOR OFFICE USE
Passed for payment of Rs.________________
(Rupees_____________________________________________)

(Authorised Signatory)

Paid vide Cheque No._____________dated __________for Rs.____________drawn on Canara Bank, Hauz Khas
Market Branch, New Delhi-110016.

(Sr. Accountant)
(Dy. Manager - Accounts)
____________________________________________________________________________________________

ICES House, Sarvapriya Vihar (Near Hauz Khas Term.), New Delhi-16, Ph:26515949, 26569493, Fax: 26513942