NARAYANA

IIT/ PMT ACADEMY

REGISTRATION FORM
Affix
passport size
coloured
photograph

Registration No.:
(for official use only)

Test Date:

Course Options
IIT-JEE

PMT

Programme Options
One-year classroom programme: 2014
OYCP (XII Studying)

IOYCP (XII Pass)

EOYCP (XII Pass)

Two-year classroom programme: 2015

ETYCP (XI Studying)
One Year Foundation Courses
Foundation I (VIII Studying)

Foundation II (IX Studying)

Foundation III (X Studying)

Batch option: (if applicable) (Write your preference by Marking 1 & 2)

Regular

Weekend

Name:......................................................................................................................... D.O.B. /./.

Fathers/Guardians name: .....................................................................................................................................
Address: House No. ......................................................... Street................................................................................
Area ....................................................................................................... City ...........................................................
State.......................................... .Pin code............................................................
STD Code: .................................Ph. No................................................Mobile..............................................................
E-mail ...................................................................................................................
Class studying /passed ................................................................... .
Percentage/Grade of marks obtained in last exam .................................................................................................
Name and address of the school attending/attended ........ ...
............

How did you come to know about Narayana IIT & PMT Academy?
[Tick/fill in the appropriate choice(s)]
a)

From Narayanas leaflet/brochure taken from .............................................................................................

b)

From advertisement (please specify the newspaper) ..................................................................................

c)

From posters/banner at ..............................................................................................................................

d)

From present/ex-Narayana student:............................................................................................................

e)

Other medium (please specify) ...................................................................................................................

Registration procedure
Submit your application form along with two passport-size colour photographs, a photocopy of the marksheet of
your last examination and registration fee for the admission-cum-scholarship test by cash or by demand draft
drawn in favour of Narayana Learning Pvt. Ltd. payable at New Delhi.

INSTRUCTIONS:
Note 1*

Specified reason & merit of the student in the Admission Test will be considered by the management
while allotting the Regular / weekend batch option.

Note 2

Registration fee is non-refundable.

Note 3

All disputes are subject to Delhi jurisdiction.

DECLARATION
I/We hereby declare that all the details stated above in this registration form are true to the best of my/our
knowledge and I/we promise to abide by the rules and regulations of the NARAYANA IIT/PMT Academy.

(Signature of Student)
Date

(Signature of Parent/Guardian)

Place :

NARAYANA IIT/PMT ACADEMY

47-B, Kalu Sarai, New Delhi 110016 Ph: 011 42707070, 42707000