FiitJee Correspondence Enrollment Form

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: query.dispatch@fiitjee.com, 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 ProgramEnrollingfor :
(for list of Programs see page no. 4)
Correspondence Programs
ENROLMENT FORM

Please Affix Your
Recent Passport Size
Colour Photograph

D D M M Y Y Y Y

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 :
(studyingor 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 tick 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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For JEE (Main & Advanced), 2015 (for Class XII & XII Pass)
I aminterested in enrolling for (Tick the appropriate box) Last date to receive completed application
Rankers Study Material (One Year Version) 20th September, 2014
One Year All India Test Series 8th November, 2014
One Year All India Test Series (By Correspondence) 15th November, 2014
Open Test 4th February, 2015
Grand Masters Package March, 2015
Rankers Test Papers File March, 2015

For JEE (Main & Advanced), 2016 (for Class XI)
Rankers Study Material (Two Year Version) 20th September, 2014
Two Year Integrated All India Test Series 29th November, 2014
Two Year Integrated All India Test Series (By Correspondence) 6th December, 2014
Open Test (in Class XI) 4th February, 2015

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, 2014

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