Date: ENROLMENT FORM

P OTO
H

Name Code of Program Enroling for :

&

Personal Information
Student Name:
Mobile: Alternate Contact No:
Email Id(in Block Letters):
Student’s Aadhaar No.: Date of Birth:
D D MM Y Y Y Y
Class: VI VII VIII IX X XI XII XII Pass/Appeared
Science + Math/PCM(%): VI % VII % VIII % IX % X% XI % XII %
Marks(if in Grades): X Board - Science Maths XII Board - P C M
Category of Student: General SC ST OBC Other Gender : M F Transgender
Correspondence Address
Address:

City:
State:
Country: Pincode:
Permanent Address
Address:

City:
State:
Country: Pincode

School Information
School Name :

(studying or passed)

City:
State: Pincode
Contact No: Alternate Contact No:
School a liated to:
ffi

Principal Name:
Principal’s Mobile: Principal’s Alternate Contact No:

Parent Information
Father Details
Name:
Email Id(in Block Letters):
Mobile: Alternate Contact No:
Qualification:
Occupation:
Designation:
Company Name:
Annual Income:

Edfora Infotech P t Ltd

Pages
v

H No . S/F alu Sarai Begumpur Mal iya Nagar Ne Delhi Delhi

32 , K , , v , w , 110017 IN 1 | 5
 ENROLMENT FORM

Mother Details
Name:
Email Id(in Block Letters):
Mobile: Alternate Contact No:
Qualification:
Occupation:
Designation:
Company Name:
Annual Income:

Payment Details

Cheque/DD/NEFT in Favor of “Edfora Infotech Private Limited”

Cheque Demand Draft NEFT/IMPS

Cheque/DD/NEFT No.: Issue Date:

D D MM Y Y Y Y
Issuing Bank Name:

Branch Name: Amount :

(inclusive of taxes)

Cheque Demand Draft

Cheque/DD/NEFT No.: Issue Date:

D D MM Y Y Y Y
Issuing Bank Name:

Branch Name: Amount:

(inclusive of taxes)

Target Exam
JEE A JEE M NTSE BITSAT

I declare that the above mentioned information is complete and true to the best of my knowledge.

Also, I have read and agree to the Terms and Conditions mentioned overleaf.

Student’s Signature: Parent’s Signature:

Name: Name:

Date & Place: Date & Place:

Edfora Infotech Pvt Ltd

H No 32. S/F, Kalu Sarai, Begumpur, Malviya Nagar, New Delhi, Delhi 110017 IN 2 | 5 Pages
 Declarations/Undertakings by the Student and Parent/Guardian
The enrolment form once placed can't be cancelled or modified for any reason. The money paid is non-refundable and
non-transferable
In addition to the above, I understand without any ambiguity that the Product Price once paid is not refundable with no
exception, whatsoever the reason may be, nor is it adjustable towards any other existing or upcoming courses on
fiitjee.mypat.in or towards the Product Price to be paid by any other existing or prospective student
It is understood that this subscription of fiitjee.mypat.in is valid only for the package and the duration for which I am
taking subscription and I/We (the student and the Parents/Guardian) shall not claim/request for subscription to and
adjusting the Product Price to any other package or duration
I/We acknowledge that the subscription provided to the student by EDFORA are the intellectual property of EDFORA and
solely for personal use as an end user and not for commercial use. Further undertake that I shall not store, publish or
make any copy of the content provided by EDFORA in digital or physical format nor shall I provide/give/distribute it to
anyone else
I/We undertake that we shall not indulge in any illegal/un-ethical/unprincipled/immoral/corrupt/dis-honest activities
which may cause loss of property, reputation and goodwill of EDFORA. I/We further undertake to indemnify EDFORA to
compensate for any loss /damages caused to EDFORA
I/We hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained
in this Enrolment Form and Declarations and agree to abide by them without any reservation or ambiguity
I/We further undertake to ensure that cheques/drafts including postdated cheques, if any, given by us will be honored
by our bankers. In the event of these cheques/drafts being dishonored, EDFORA is at liberty to initiate any action
against us including legal proceedings under section 138 of Negotiable Instruments Act or other appropriate law
I/We agree & understand that on submission of this enrolment form, I/We have the right to use the product as an end-
user. It is clearly understood without any ambiguity that myPAT product fee is payable irrespective of the use of the
product by the student
I/We know that registered office of EDFORA is situated at New Delhi
I/We understand that in case of any dispute, the jurisdiction will be an appropriate court/forum in Delhi/New Delhi Only
I/We promise to abide by all rules and regulations of EDFORA declaration in true letter and spirit
I/We agree and understand that EDFORA is not responsible for any inconsistency in the system generated user
performance analysis and the actual performance of the same user in the actual target exam
I/We agree and understand that Parents are solely responsible for ensuring no unethical means is used in assessment
by the student to ensure analytics is appropriate reflection of student's standing
I/We agree to abide by the terms and conditions mentioned under "Terms of Use", "Privacy Policy", and "Copyright"
Section published on fiitjee.mypat.in and acknowledge that I have read and understood the "Disclaimer" published on
the fiitjee.mypat.in website
In the event of any dispute between the parties regarding the interpretation of clauses of enrolment form or any claim
etc. the matter shall be referred to the Sole Arbitrator appointed by EDFORA. The arbitration proceedings shall be
conducted in accordance with the provisions of the Arbitration & Conciliation Act, 1996 and statutory modification
thereof & rules made there under. The decision of the arbitrator shall be final & binding on both parties. The Venue of
Arbitration shall be Delhi/New Delhi only
The GST has been calculated @18% as per the current prevailing tax rates/laws and is subject to revision with change in
governing GST laws/rules.
I declare that I have retained a photocopy of this document before submitting it to EDFORA.

Student's Signature: Parent's/Guardian's Signature:

Name: Name:
Date and Place: Date and Place:

Edfora Infotech Pvt Ltd

H No 32. S/F, Kalu Sarai, Begumpur, Malviya Nagar, New Delhi, Delhi 110017 IN 3 | 5 Pages
 Terms & Conditions for postdated cheque(s)

I declare that under no circumstances I will be eligible for refund of fees and withdrawal of post-dated cheque(s) issued
by me in favor of Edfora Infotech Private Limited for whatsoever reasons
I declare and agree that all post-dated cheques issued by me shall be honored and cleared, even if my child/ward
withdraws or otherwise discontinues to use the product for whatsoever reasons
Further I understand that EDFORA shall suffer irreparable losses in case of non-payment of remaining fee of the
installment plan, hence it will be unethical not to honor the Post-Dated Cheque(s). I have opted for installment fee plan
and have submitted the post-dated cheque(s) as per the details give below.

I agree that I will make suitable arrangements for the below slated post-dated cheques to get honored and will keep
sufficient funds on or before the due date for the same.

Detail(s) of Post dated cheque (Only Local/Payable at par Cheques will be accepted)

Product Fee
Total

S.No. Cheque No. Date Issuing Bank GST

Amount Amount

I further agree to get above post dated cheque(s) cleared, even if my son/daughter/ward discontinues the use of product
for any reasons.

I am signing the above declaration in good mental/physical health and have satisfied myself about EDFORA. The Enrolment
Form was received by me several days before the actual date of signing to enable me to understand the contents of the
same, I have taken legal expert opinion regarding the matters which were not clear to me and I am satisfied.

Student's Signature: Parent's/Guardian's Signature:

(who has issued the cheque(s))
Name: Name:

Date: Date:

Place: Place:

Edfora Infotech Pvt Ltd

H No 32. S/F, Kalu Sarai, Begumpur, Malviya Nagar, New Delhi, Delhi 110017 IN 4 | 5 Pages
 Consequences of Dishonoring of Post-Dated Cheque(s)

I understand that non-clearance of any of the post-dated cheque(s), submitted for payment of myPAT Fee (on installment

basis) as mentioned in this Enrolment Form is punishable under Sec 138 the Negotiable Instrument Act. I understand that

EDFORA shall be entitled to proceed and initiate appropriate legal action against me, to recover the amount of the post-

dated cheque(s) along with the legal expenses and out of pocket expenses incurred by EDFORA.

In case any of my post-dated cheque(s) bounces for any reason whatsoever, I undertake to submit a DD/Pay-Order in favor

of "Edfora Infotech Private Limited" payable at New Delhi, within four days of the bouncing of the cheque(s) at my bank,

together with Rs. 500/- (Rupees five hundred only) as default money along with late payment of Rs. 50/- (Rupees fifty only)

per day up to 10 (ten) days from the due date of payment of installment after which my son/daughter/ward shall be

debarred from using the product without any further notice and I shall have no claim for refund of fees or any support

besides legal action inter-alia action under Section 138 of the Negotiable Instrument Act may be initiated against me.

Student's Signature: Parent's/Guardian's Signature:

Name: Name:

Date: Date:

Place: Place:

For Office Use only:

Name of the official processing the Form: UDIT SAWHNEY

Employee Code: 35403

Signature:

Payment Acknowledgement

(For Official Use Only)

Name: Place: Email:

Enrolment No: EIPL- 1. Cheque/DD/NEFT No.: Amount

2. Cheque/DD No.: Amount

Accountant

Edfora Infotech Pvt Ltd

5 | 5 Pages
H No 32. S/F, Kalu Sarai, Begumpur, Malviya Nagar, New Delhi, Delhi 110017 IN