VIVITALIA - 11th Floor, Urmi Estate, 95, Ganpatrao Kadam Marg, Opposite Peninsula Business Park, Lower Parel

West,
Mumbai 400013, Maharashtra
T: +91 9833441732 F: +91 22 6772 8291 E: language@indiaitaly.com W: www.indiaitaly.com CIN: U74999MH1966NPL013602

Enrolment Form (please write in capital letters):

NAME AND SURNAME: _ANESLEY ANDREW

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ADDRESS: A-43 JALADA, TWIN TOWER LANE, PRABHADEVI, MUMBAI- 400025__

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TELEPHONE/MOBILE NO.:
_____9820485439____________________________________________________________________________________

E-MAIL ID (please write in capital letters): -

____MAXANESLEY@GMAIL.COM________________________________________________________________________

DATE & PLACE OF BIRTH: (day/month/years)_____31/03/1999; Kerala

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WHY DO YOU CHOOSE TO STUDY ITALIAN?

____Hobby______________________________________________________________________

OCCUPATION:
_____STUDENT____________________________________________________________________________________________

IN WHICH FIELD DO YOU WORK?

_____________LAW______________________________________________________________________

NATIONALITY:
__________INDIAN________________________________________________________________________________________

ACADEMIC QUALIFICATION: _______FINAL YEAR (BA LLB)

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LEVEL OPTED FOR: (TICK THE APPROPRIATE ONE)

LEVEL I –BASIC LEVEL II – LEVEL III – LEVEL IV – LEVEL V –
INTERMEDIATE PRE - ADVANCED ADVANCED DIPLOMA

REGISTRATION FEES PAID RS. 11.800 (CHEQUE/D.D/CASH) DATE: _________________________

SIGNATURE OF APPLICANT: ___________________________

Terms and conditions

1. The amount stated for the course includes: textbook and educational materials, final exam, taxes,
cultural material, movies, songs and audio material.
2. The Institute will be closed on some Bank Holidays (to be intimated by the professor)
3. Cancellation of enrolment must be made via registered mail / fax at least 15 days prior to the
beginning of the course: in which case 80% of the deposit will be refunded otherwise the deposit will
be forfeit.
4. Students who do not complete the course will not be entitled to any refund.
5. In the event of insufficient enrolment in any course, the Institute reserves the right to cancel the
course and will refund the full amount of the deposit paid.
6. To learn a language is very important to practice and to practice you must attend all classes.