ADMISSION FORM FOR CLASSROOM/HYBRID COURSE

☑ I understand and agree that the personal information will be collected by Aakash Educational Services
Limited (“Company”) while submitting the admission form and the personal information may be used or
stored by the Company as mentioned under the Company’s Privacy Policy. I have read and agree to the
Company’s Privacy Policy in it’s entirety

Form Filled by Parent and I agree that at the time of filling the admission form my age is 18 or above.

PSID: Branch
00010058188 Darbhanga Branch

Stream: Term
Medical 2325

Course Name Batch Option

TY- Two Year Integrated Classroom Weekdays-Morning
Course for NEET - after board -
713277

Personal Detail

Student Name: Chandani singh

Date of Birth 03/01/2008
Gender Female
Category GENERAL
Student Email ID : nitusingh72m@gmail.com
Primary Mobile No. 7688994504
Secondary Mobile No. : 8209709840
Father’s Name : Deepak singh
Mother's Name Neetu singh
Parent's/Guardian's Occupation : Indian Armed Forces
Nationality : India
Blood Group : B+

Address Details

Correspondence Address

Address: Darbhanga
Pincode: 846009
State: Bihar
City : Darbhanga
Phone No :
Parent's Email ID : dipak72m@gmail.com

Permanent Address

Address: Darbhanga
Pincode: 846009
State: Bihar
City: Darbhanga
Phone No:

Education Detail

Class Studying: 10
Exam Board: CBSE
School State: Bihar
School City: Darbhanga
School Name: KENDRIYA VIDALAYA NO. 2
Marks Obtained in last class %: 79%
Grades Obtained in last class: Math :

Science :

Original marksheet of the last board or equivalent exam

Copy of Identity Card issued by Aakash

Date: 29-04-2023
☑ I hereby authorize the Company and/or its service provider(s) to reach out with transactional/promotional/
other information on my coordinates (whatsapp/ email/ mobile number)
☑ I hereby acknowledge that the information and/or documents provided by me are correct and true. In case of
any discrepancies in the information provided by me, Company shall reserve the right to cancel/reject my
application form
☑ I hereby read, understood and agree the terms and conditions of the Company.

The details of the admission form has been verified by the customer through OTP authentication
on mobile number 7688994504 and 8209709840 at 29-04-2023 19:41:08 at 157.35.26.255