Gas CATION FORM Form No, 6 FOR OFFICE USE ONLY OOJA | ex cop No. BANSAL CLASSES MEENTUTOTIANS. |r ceckes by TEE oes Foundation Division POT Signature: Date: CERT Please fill this form with a Black / Blue pen In BLOCK Letters only. (Photocopy of ths Apoication Form can nat be used COURSE APPLIED FOR (Rote Information Brochure) Please Uk (v) [banal ciasses Pooja Tutorials (efeuttseye yaeme Nicleue | EJorigin fJapex [Peart [Gravion []denith [ifstering [fata en come ait of oo Fed on er tpt ie Asad rah Cor) JE Wain ppeton For No JEE Advanced Appcaton Form No,[_—] EE Main Roto] PTSEDate;__— (omy) Medium of studies: in [hi 1. Details aboutthe Student (A) Name ofthe Student Paste your recent passport size (@) Fathor'sName, Ly color photograph her. (0) Mother's Name (0) Dateorei (ooMMYYYY) —(E)Gender(v) Male] Femate[] (00 Nor staPLe) © cateon) QOOOOO 2. Communication Details (A) MobileNo. (Student) (8) E-maillo Student (€) Permanent Addross (©) Comespondence Address: Pane erin tft PIN PIN (Pad a anor yor Fer ren Bas alos bane Fw bso wt he Sree Bons) Tal.No. Tal No, 3. Details about Your Sibting Name (Brother Sister) Class presently studyingin Name2 (Brother Sister) Class presently studyingin 4. Details of your Scholastic Achiovementsinany ofthese exams (Pleasetick(v)&giveits dt ntseL] sstseQ] KvevL] oymolass(] sar] oters] o Pro.5. Areyoutaking any specialized Coaching for Competitive Exams Pleasetick(v)}: Yes[_] Nol] Since (veer) yes, Name afyour Coaching Institut, Your OverallRankin your Coaching nstute Particulars Father Mother Name ‘Qualification ccupation Designation ‘Company Namo ‘Company / Office Address Company / Office Tel. No. ‘Mobile Ne. E-Mail (In BLOCK Letters) 7. Details aboutthe School Presently Studying in/LastAttended. (A) SchoalName& Address ty Town PIN, state Phone: (8) Namoct your School Principal (©) Studyingin class, (©). LastAnnualExam/@oara Exam Aggregate Mars (%) Declaration by the Student / Parent / Guardian + 1Wehave received &readthe Terms & Conditions printedinthe Information Brochure + Thereby declare thatthe information provided by me inthe Application Form ae tue and coracttoebestof my knowladge. Regisration/Application Form Fee willnotbe refundedtin any case or transfered to any other Admission Test Date + Once a student joins the study conte ofered irrespective of his/her choice of study contre opted bela joining) no request for change of study contr willbe tenlertained,norhe course fee paid willberefunde under any reumstances, + Institute reserves therightto change cancel any Program, TestCenre, Study Cant, sll riterion & Course Fee without any priornotice, + Ifgotsolected in NTSE, Olympiad, KVPY, JE (Main), JEE (Advanced) orany other compottive Examithe sole crest ofmyselucton goosto Bansal lasses. & Pooja Tutorals, Jur only +The Registered Offce of Bansal Classes & Pooja Tutorials st Jalur.n case of eispute, studens / parents are subject fo the exclusive jurisdiction of appropriate cours in Jaipur only. All eieputes snall be refered ta the Sole Arbitrator appointed by the Bansal Classes & Pooja Tutorials. The decsion of the arbitrator shal be final & binding. The arbitrator so apponted shall not be Incapactated for reasons of ther being the employee of Bansal Classes & Pooja Tutorials. ois sister concom and far reasons of having any plot Inkage wih the company, + Mysignature below certifies that have read, understood and agreed to the all ula and regulation, + Thave retain a photocopy ofthe complete Application Form for my records. + All ¢isputes are subjected to Jaipur (Rajasthan) Jursditon only Uwe hereby declare thatthe information furnished onthis Application Formis corecto the bestof my knowledge and boli Not nly for Aza Course: FEE lb palin one insane only Fees depose anc wl nol be rofnded in any crcumstancs whatsoever. Whether you have qualified oF not quae for JEE(ADVANCED), Date Cosas aa Brace Poe Go Place Ree atcuaeny ‘Nae Paen Ga) POOJA TOWER, 3, Gopalpura Bye Pass, Jaipur © Ph. 0141-51181 156 + Web : www ejipu com, www poojatutrias. com