You are on page 1of 3

517, 5th Floor East Wing Arora Towers, Mg Road Camp Pune-411001 Tel: 8208182665

COURSE: VENUE: _______________
DATE: ________________


(Surname) (Name) (Father’s Name) (Mother’s Name)

HOME ADDRESS:_________________________________________________


Tel: ______________________ EMAIL:____________@_________________

Date Of Birth: _ _/__/____ Age:_______ SEX: MALE FEMALE

Std. in Which Studying: _____ STREAM: Arts Science Commerce

MARKS IN SSC/CBSC/ICSC/HSC/IGSC ______ MATHS: _______________
SCIENCE: _______ Agg. %: _____________

FATHER’S NAME: (in full) ________________________________________________

Profession: Service / Business Designation:__________________

Company Name: _____________________ Department:___________________

Company Address:______________________________________________________

____________________________________________ Tel:_________________

I am Closing A _____________ Balance Payment A _____________
(This Admission Card is request towards
Being admitted for given course. I have read
all the rules and regulations and undertake
to abide by them.) Signature of Parent/Student/Legal Guardian

If any. on his own sweet will after giving due consideration to rigors of time. in letter and spirit. In the event of these cheques/drafts being dishonored. In such a case I or my father / mother / legal guardian shall have no claim for any type of compensation/refund of fees. 10. Declaration 1. Date : _____________ Countersigned by father/ mother/ legal guardian Signature Student Signature Place : _____________ Name : _________________ Name:_________________ FOR OFFICE USE ONLY SP. 5. I/we further undertake to ensure that cheques/drafts including post dated cheques if any given by us will be honored by our bankers. 6. I am taking admission in SHIKSHA PLUS with the consent of my father / mother / legal guardian. I hereby declare that the information in the admission form is correct to the best of my knowledge and belief. I understand that if I leave the institute before completing the full course for any reason whatever. nor is it adjustable towards any other existing courses at SHIKSHA PLUS or any yet to be launched nor towards the fee of any other existing or prospective student. I understand without any ambiguity that the fee once paid is not refundable at all. 9. 8. unless otherwise allowed in writing. I shall not be allowed to attend the classes till the needful is done. after studying SHIKSHA PLUS brochure and being satisfied in all respects. including: (i) Transfer of father / mother / legal guardian s/ill health of myself or any other member of the family or (ii) Timing inconvenient (iii) Does not want to continue (iv) Medical reasons (v) My admission in any institute / course / engineering college Myself. SHIKSHA PLUS is at liberty to initiate any action against us including legal proceedings to include invoking provisions of section 138 of Negotiable instruments Act. In addition to the above. REMARKS: _____________________________________________________________ ___________________________________________________________________________ BASIC COURSE FEES: ___________________ Approved By_________________ PHOTO . whatever the reasons be. I have read the above carefully and have understood it clearly. 7. distance and studies ahead and with the permission of the father/ mother / legal guardian without any coercion from any side. If any discrepancy in the information given or otherwise is found at any stage of my association with SHIKSHA PLUS. 4. I promise to abide by all rules and regulations of SHIKSHA PLUS declaration. 11. 2. I have kept a photocopy of the all page of this enrollment from including this declaration for my future reference and timely compliance. 3. It is understood that this admission is valid only for the course and the duration to which I am taking admission and I/We (the student and the parents) shall not claim/request for adjusting the fees to any other course or duration. any action deemed fit by SHIKSHA PLUS including my expulsion from the institute may be taken against me. my father/mother/legal guardian shall have no claim for refund of fees. up to two days prior to the start of the classes. I understand that if I fail to compete / submit all remaining formalities/documents. I/we further declare that the above named student is taking admission in the SHIKSHA PLUS having considered everything material.

Receipt No Cash/Cheque Date Remarks .