Register Form No :

Enquiry Form No :............................

STUDENT ENROLLMENT FORM

Personal Details
Student Name :...............................................................................................................................................................................
Fathers Name / Spouse Name :........................................................................................................................................................
Date of Birth DD MM YYYY Sex : Male / Female
Present Address : ...........................................................................................................................................................................
Affix your recent
.......................................................................................................................................................................................................
Photographer here
City : ............................................................................... Pin Code ..............................................................................................
Land Line Number : ........................................................... Mobile Number .....................................................................................
E - mail Address : ...........................................................
Education Background For Office use only
Degree : ...................................................... Invoice No :..........................................................
(Commerce / Arts / Science) Institution Name ........................................ ............................................................................
In case presently studying then Year in which you are into : Course :...............................................................
+2 ............................................................................
Degree I Yr Batch Start Date :................................................
II Yr ............................................................................
III Yr Batch End Date :..................................................
IV Yr ............................................................................
Others (Pls specify) If employed Timings :..............................................................
PG Degree Current Organization & Address : .................
Degree I Yr ..................................................................... Down-payment Rcpt No / Full Payment Recpt.
II Yr Designation .................................................. No :
MBA 1st/2nd Total Years of Experience .............................
Down Payment (Rs.) Installments
1 2 3 Total
Registration

Tuition Fee
Courseware
Fee

Others

Sub Total

Date of Receipt Due Date Due Date Due Date

Terms and Conditions :

1. This is a training institute and no employment and or placement guarantee is given either by the staff or Institute or any other person through whom the candidate joined the institute.
2. Mode of payment : Cash / Demand draft / Cheque drawn in favor of **.
3. All paid Fees are non - refundable.
4. Rights of admission reserved. Any candidate who misses five consecutive classes will not be allowed to rejoin without the written permission of Centre Head
5. Management reserves rights to make any changes in the course, including the timing, without prior notice / consent which is binding on the Management and canot be questioned

Declaration
I agree to the above terms and conditions. I further agree to abide by the rules and regulations of the Institute as is prevalent from time to time

Date: .................. Signature of the Centre Head Signature of Counselor Signature of Applicant