For IIT JAM, JNU, GATE, NET, NIMCET and Other Entrance Exams VPM CLASSES 1-C-8, SFS,

Talwandi, Kota (Rajasthan) -324005 Ph. (0744) 2429714, 09001297111 Website: www.vpmclasses.com Email: vpmclasses@yahoo.com
Registration No.: (for official use only)

Please Affix Your Recent Passport Size Photograph

APPLICATION FORM

Please select the correspondence course for which you wish to enrol. IIT JAM YEAR: 2010 CSIR-UGC-NET 2011 2012 GATE 2013 OTHERS
(please mention the details in course name below)

SUBJECT: _______________________________________

COURSE NAME: ______________________________________________________________________________

PERSONAL INFORMATION (All the fields are compulsory): Name of the Candidate: ___________________________________________________ Sex: Male Female

Date of Birth: DD______/MM______/YYYY_________ Fathers Name: ___________________________________________ Correspondence Address: ______________________________________________________________________________

______________________________________________________________________________________________
Ph. (Res.) with STD Code: _____________________ Mobile No. _______________________

E-mail ID of the student: ________________________________ Educational Background: Exam Name of school/college passed Board of Education Year of passing

% of Marks

Rank/Class

X XII BSc 1st yr BSc 2nd yr Other

Course Fee payment details: Demand Draft no. Drawn on Bank Amount

Registration procedure Submit your application form along with two recent passport-size colour photographs, Xerox copy of 10 th, 12th and Bachelor degree marksheets (Masters degree marksheets also, if applicable) and demand draft drawn in favour of VPM Classes payable at any bank at KOTA, RAJASTHAN. Send all the items to the VPM Classes postal address (mentioned in the top left box of this form) Note: Fee of any program is not refundable at any stage.
1. 2. DECLARATION I declare that all the information furnished in this Application Form is correct to the best of my knowledge. I understand that in the event of any information found to be incorrect or false, my admission may be cancelled without refund of fee. I will provide VPM Classes with the details (Roll Nos. etc) of the entrance exams which I may appear in the future. I shall not withhold this information from VPM Classes, who are entitled to know the results of their efforts to help me get through the exams. VPM Classes reserves the right to use the photograph for publicity if I am successful in the Entrance Exams. All legal disputes are subject to jurisdiction of the Courts / Authorities of Kota, Rajasthan only.

3.

Signature (Student)

Date :.......................