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DIVINE MATHS ACADEMY,BOPIYA

(An institute for bright future),7426979696,7296967373

Appl No. Stamp Size


ADMISSION FORM Photo

Name & code of centre

Session : 201 - 201 Academic / Calendar Year


STUDENTS PERSONAL INFORMATION (FILL IN BLOCK LETTERS)

1. NAME________________________________________________________________________________

2. DATE OF BIRTH ______________________________________________________________________


(As Per Mark Card)

3. PROGRAMME / COURSE OPTED

4. PLACE OF BIRTH &


DISTRICT
5. MOTHER TONGUE 6.

7. SEX: MALE FEMALE 8. NATIONALITY

9. NAME OF FATHER/GUARDIAN

10. NAME OF MOTHER

11. POSTAL ADDRESS OF


APPLICANT

12. CONTACT NUMBERS : OFFICE MOBILE


(with STD code)
RESIDENCE E-MAIL

13. CATEGORY 14. ANNUAL INCOME

15. SUBJECTS 1. 2. 3.
16. FEES EMI-1…………. 2………….. 3…………………….

17. Nationalized Bank A/C No. of Candidate

Bank Name & branch

Bank IFS Code Bank IFS Code

18. Qualifying Last Examinations Passed


Examinat Board/University Reg No. & Year of Marks %Of Class
ion passing obtained Marks Obtained
Passed

COMPULSARY FOR ALL CANDIDATES SEEKING ADMISSION IN DIVINE INSTITUTE


I agree & abide by all rules, regulations, Terms & Conditions of Divine maths academy.
& I know that my admission is subject to, final approval by School & payment of institute fees in
time, without which admission will be deemed as cancelled without any intimation & assigning any
reason. I know that all notices, information’s, correspondences should be updated from coaching
website time to time by my self & in no way institute will be held responsible for any inconvenience
& any type of delay. I know that my personal Email ID is compulsory and maximum correspondence
will be done through Email from institute side.

Ia

Signature of the Applicant


I agree & abide by all rules, regulations, Terms & Conditions of DIVIINE MATHS ACADEMY as
Parent of above Candidate.

SIGNATURE OF THE PARENTS

Verification
I have personally verified all contents in application & documents & found Correct.

Head of Admission/Training/ coaching Centre


Application forwarded / not forwarded

Principal / Director

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