1/6/2016

VibrantAcademy(I)Pvt.Ltd.

RegistrationForm(201617)
OldVibrantStudentsOnly

ForOfficeuseonly

VibrantRollNo.
Session.

VibrantFormNo.
VibrantRollNo.

IfPaybyDDthenAttachDDofRs.1000/infavourofVibrantAcademyIndiaPvt.Ltd.
PayableatKota(Raj.).WriteUId,CandidateName,AddressandMobilenoatthebackofDD
IfPayonlineClickhereSendprintofformtoVibrantAcademyKota
Note:AttachcopyofpancardandIdProofwithPrintedForm
UId

102656

CourseName:MicroPhaseII

TestCenter(1stChoice)

Bhilai

2.

DateOfBirth

18May00

Gender:Male

StudentName

ISHANMANDAL

MotherName

BARNALIMANDAL

FatherName

AMARMANDAL

FatherOccupation

GovtService

Designation

SR.DMO

Deptt.

MEDICAL

PermanentAddress

88/C/1,,SOUTHRAILWAYCOLONY

City
Email
Mobile(Student)
LastClass
NTSEStage*

GONDIA
rkmnrs@gmail.com
9571361464
X
NotApplicable

State
Phone
Mobile(Father)
NTSEIIStage.
Category

Pastelatest
PassportSize
ColourPhotograph

Maharashtra441601
9730078507
No
SC

*NTSEsecondstagequalified.PleaseAttachproof
Class

School

Year

Board

Maths

Sci

PCM

Aggr

2014

CBSE

a1

a1

NA

a1

IX

gondiapublicschool

NA

XI

NA

NA

XII

NA

NA

ifpaybyDDthenDDDetails
DDNo.:____________________________________
DDAmount:________________________________

BankName:_______________________________________________
DDDate:__________________________________________________

IfPayOnlinethenwriteReceiptNo.
ReceiptNo.:___________________________________

DetailsofPriv.CoachingInstitute

DetailsofPriv.CompetitiveExams

InstName:
RollNo:Batch:Cum.%:
City:

Jee(Main)Marks:0Jee(Main)Rank:0
Jee(Adv.)Marks:0Jee(Adv.)Rank:0

TestDate:1042016
Signature(Applicant)withDate
http://www.vibrantacademy.com/User/form.aspx

Signature(Father/Guardian)withDate
1/3

1/6/2016

VibrantAcademy(I)Pvt.Ltd.

Studentsmustsubmitattestedcopyofrelevantdocumentas
proof.

GeneralRules

Mention your Correct Email Address, while filling

applicationform..

Please keep visiting our web site at regular

intervals to keep yourself updated with the
current happenings & your academic
performance.

Student will attend their classes in their own

batches non compliance of this will result into
suspensionforoneweekandlossofstudieswill
notbecompensated.

Admit card for entrance test will be available

three days before the test date on our website
candidatescandownloadthesame.

If the student indulges in any kind of unfair or

unsocial activity, it is the responsibility of the
student and his parent only. The institute bears
noresponsibilityforthesame.

Commutation to institute will be the sole

responsibilityofthestudent.Ifanymishapoccurs
during travelling to the institute it is solely the
responsibilityofthestudent.

Medium of instruction is English only and all

literatureprovidedbyusissolelyinEnglish.

Signature of applicant and father / guardian on

both sides of registration form is must, otherwise
formwillberejected.

Students found using mobile inside the campus

will be fined as : First Time Rs. 200/, Second
Time Rs 300/, Third Time Rs. 1000/ and after
thatMobilewillbeforfeited.

Pleasesaveyourtimebycheckingyour
registrationstatusonourwebsite.Gettinga
telephonicreplyinthisregardmaybetime
consumingduetorushontelephoneline.

LossofIcardwillincurafineofRs.200/.

In case any student is found seeking admission

by fraudulent means he / she will be removed
fromtherollsoftheInstituteimmediatelyandno
refund of fee/caution money etc will be made
underanycircumstances.
We reserve the right to delete any course and
denyforadmissionwithoutassigninganyreason.

Declaration:
WehavereadtheRefundRulesaswellastheGeneralRulesandagreetoabidebythem.

Signature(Applicant)
withdate

Signature(Father/Guardian)
withdate

YouareadvisedtoretainaphotocopyofdulycompletedRegistrationFormforyourrecords

http://www.vibrantacademy.com/User/form.aspx

2/3

1/6/2016

VibrantAcademy(I)Pvt.Ltd.

IfPayOnlineClickhere

http://www.vibrantacademy.com/User/form.aspx

3/3