En r o l m e n t F o r m(for Classroom / Integrated School Programs) Enrolment Number (for official use only) v Make a photocopy of this form after filling the required information and before submitting it to FIITJEE. 9.com/regupdate. .htm to update your Contact Details online using Registration Number and web access code printed on your Hall Ticket.fiitjee. v Log on to www. v Any one of the following documents : n Photocopy of School ID card with photograph or n Photocopy of last Board or School Marksheet supported by any Identity Proof of student or n Photocopy of Transfer Certificate or n Bonafide certificate issued by the Principal of School with student’s photograph Original should be presented for verification at the time of admission. v Admission Test / FTRE / FTSE / Fortunate . 13). v One stamp size photograph (should be pasted on page no. 13 and Three photographs should be submitted along with this Enrolment Form). Please Note : v Check the availability of the program at your preferred FIITJEE centre before making a choice. Two on page no.40 Hall Ticket (in Original). Items required to be submitted along with this form : v Six identical passport size colour photographs of the student (One photograph should be pasted on this page.Instruction for filling Enrolment Form Please read carefully the “Important Information for Students (& their Parents / Legal Guardians)” and “Declarations / Undertakings” section on page no. v Admission offer letter (in Original). 10 & 11 respectively before filling this Form. 13 & 14) Scholarship Awarded % (if applicable) : _________________________________________________________ : ________________________________________________________________________ : ________________________________________________________________________ : ________________________________________________________________________ Student’s Name (in Block Letters) Date of Birth Mailing Address : _______________________________________________________________________________________ : ________/_______/___________ E-mail ID :_________________________________________________ : _______________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ Contact No (Mobile) Permanent Address (if any) : ____________________________ Land Line (with STD Code) : ___________________________________ : _______________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin :_________________________________ Contact No. Service Others (please specify) : __________________________ Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ E-Mail ID : ________________________________________________ Mobile No : ___________________________ (b) Mother‘s Name Occupation : Business : ________________________________________________ Qualification : _________________________ Govt. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________ School/College Last Attended / Presently Attending : _____________________________________________________________________ Address : _______________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ (a) Father‘s Name Occupation : Business : ________________________________________________ Qualification : _________________________ Govt. Service Pvt. Service Pvt.Enrolment Form Test date : ______/______/_____________ Please affix the 1st passport size colour photograph of the student here Registration Number (as mentioned on the Hall Ticket) :_______________________________________________ Study Centre Program Name (refer page no. 13 & 14) Program Code (refer page no. Service Others (please specify) : __________________________ Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ E-Mail ID : ________________________________________________ Mobile No : ___________________________ 3 . 1 2 3 4 Total Instrument Number Dated Issuing Bank & Branch Amount (in Rs. Service Others (please specify) : __________________________ Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ E-Mail ID Mailing Address : ________________________________________________ Mobile No : ___________________________ : _______________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin: _________________________________ (d) Details of the Sibling(s) 1. No. Name Class studying in : _______________________________________________________________________________________ : ___________________________ Enrolment No.Enrolment Form (c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler) Local Guardian’s Name Occupation : Business : ________________________________________________ Qualification : ________________________ Govt. Name Class studying in (if applicable) : _______________________________________________________________________________________ : ___________________________ Enrolment No. Service Pvt.) 4 . (if enrolled with FIITJEE) :_________________________ Details of the examination(s) of the class last passed / currently studying Name of the Examination(s) Board Year of passing / appeared Total Aggregate Marks (%) PCM / Science + Math (%) Fee Details : Fee Plan opted (√): Fee Plan Code (please refer course fee Annexure) I □ II □ III □ : _______________________________________ Detail(s) of Demand Draft(s) / Pay Order(s) S. (if enrolled with FIITJEE) :_________________________ 2. Name Class studying in : _______________________________________________________________________________________ : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________ 3. I will make arrangement. I have taken expert opinion regarding matters which were not clear to me and I am satisfied. Signature of the Student Name : ____________________________________________________ Enrolment Number (for office use only) : __________________________ Father / Mother / Legal Guardian’s Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________ Date : _____________________________________________________ I have retained photocopy of this document for my reference before submitting it at FIITJEE. I am signing the above declaration in good mental / physical health. including this form was received by me several days before the actual date of signing to enable me to understand the implications of taking admission at FIITJEE. to get honored. Date : _________________________________ Place : _________________________________ 5 Father / Mother / Legal Guardian’s Signature Name : ______________________________________ . for below stated Post Dated Cheque(s).Enrolment Form Annexure “A” TERMS & CONDITIONS FOR POST DATED CHEQUE(S) I understand that if my son /daughter / ward withdraws from the Program to which he/she has been admitted at any point of time or does not attend the Program and thus the seat given to him/her is rendered vacant. hence it will be unethical not to honor the Post Dated Cheque(s). Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted) S. The necessary Enrolment-Forms. I agree that. I have opted for installment fee plan and have submitted the Post Dated Cheque(s) as per the details give below. the same will not/can not be filled up by any other candidate and a vacancy created in the batch due to withdrawal of a student after the starting of classes or up to 2 days prior to the same cannot be filled in any case. No. Tax Amount Total Amount I further agree to get above Post Dated Cheque(s) cleared. irrespective of any reasons. my son / daughter / ward discontinues studies at FIITJEE. therefore I understand that FIITJEE shall suffer irreparable losses in case of non-payment of remaining fee of the installment plan. parents / guardian Cheque No. even if. I have satisfied myself about FIITJEE. and will keep sufficient funds on or before the due date for the same. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Affix one self attested passport sized photograph of the person issuing Post Dated Cheque(s) i.e. Dated Issuing Bank Fee Amount S. Enrolment Form Annexure “B” CONSEQUENCES OF DISHONOUR OF POST DATED CHEQUE(s) I understand that non-clearance of any of the Post Dated Cheque(s). to recover the amount of the Post Dated Cheque(s) along with the legal expenses and out of pocket expenses incurred by FIITJEE.” payable at New Delhi. 138 (B) of the Negotiable Instrument Act. Signature of the Student Name : ____________________________________________________ Enrolment Number (for office use only) : __________________________ Father / Mother / Legal Guardian’s Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________ _____________________________________________ Date : _____________________________________________________ _____________________________________________ I have retained photocopy of this document for my reference before submitting it at FIITJEE. I undertake to submit a DD/Pay-Order in favour of “FIITJEE Ltd. Date : _________________________________ Place : _________________________________ Father / Mother / Legal Guardian’s Signature Name : ______________________________________ 6 . submitted for payment of fees (on installment basis) as mentioned in the Enrolment-Form and annexure “B” is punishable under Sec. 500/. within four days of the bouncing of the Cheque(s) at my bank.(Rupees five hundred only) as default money alongwith late payment of Rs.(Rupees fifty only) per day upto 10 (Ten) days from the due date of payment of instalment after which my son / daughter / ward shall be debarred from classes without any further notice and I shall have no claim for refund of fees or any support in studies besides Legal action inter alia action under Section 138 (B) of the Negotiable Instrument Act may be initiated against me/us. In case any of my Post Dated Cheque(s) bounces for any reason whatsoever. together with Rs. I understand that FIITJEE shall be entitled to proceed and initiate appropriate legal action against me. 50/. ) 10. Please mention any other information relating to the student.Enrolment Form Annexure “C” PARENT DATA SHEET (CONFIDENTIAL) Dear Parent / Guardian. What is the student’s biggest weakness? : ______________________________________________________________________ 9. The right and accurate feed back of your ward/student will give us an opportunity to understand the student better which will help us in providing better support & education. when and why? (You may attach a blank page if required. My son / daughter / ward has a sound moral character & sense of responsibility. Name of the Student 2. Have there been any major changes in the student’s attitude towards studies till now at any time. which help make FIITJEE understand the student better. Relation with Student : ______________________________________________________________________________ : ______________________________________________________________________________ : ______________________________________________________________________________ 4. 1. Father’s/Guardian’s Name 3. How would you rate the student in the following characteristics ? (√ the appropriate) Excellent Sincerity Leadership Imagination Emotional stability Ability to work with others Ability to work hard Perseverance Good Average Below Average Low Unknown 6. This information will be confidential. What is the student’s class rank? : ____________________________________________________________________________ 7. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 11. Is the student’s record an accurate index of his/her capabilities? Yes / No If no. He/she also has good physical and mental health to successfully cope up & complete his/her studies at FIITJEE and fulfill all terms & conditions. Some gifted individuals make mediocre scholastic records. Father / Mother / Legal Guardian’s Signature Date : _________________________________ Place : _________________________________ 7 . if so illustrate. state why? : ______________________________________________________________________________ 8. the parent / guardian and/or the student. Enrolment Form duly filled in 4. Signature of the Student Father / Mother / Legal Guardian’s Signature Name : ________________________________________ Address : _______________________________________ ________________________________________________ Name : ____________________________________________________ Enrolment Number (for office use only) : __________________________ Date : _____________________________________________________ I have retained photocopy of this document for my reference before submitting it at FIITJEE. Admission offer letter (in Original) 8.5 x 2 cm. that the fee once paid is not refundable at all. “B”. Annexure and Declarations and agree to abide by them without any reservation or ambiguity.40 Hall Ticket (in Original) 7.Enrolment Form Annexure “D” Kindly do not take admission at FIITJEE if the clauses of the declaration on the Enrolment Form on page no. hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form. 10 & 11 is not agreeable to you. Demand Draft(s) / Pay Order(s) for the fee 2. Date : _______________________________ Place : _____________________________ Father / Mother / Legal Guardian’s Signature Instruction : After filling-up annexure “A”. Annexure “A” to “D” 5. “C” & “D” please retain photocopy of the same before submitting at the FIITJEE Checklist : 1. whatever the reasons be. Local / at par post dated cheque(s) 3. (One) 6. Declaration 22 : I/We. Any one of the following documents : (a) Photocopy of School ID card with photograph or (b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student or (c) Photocopy of Transfer Certificate or (d) Bonafide certificate issued by the Principal of School with student’s photograph 8 . I understand without any ambiguity. Colour Photographs: (a) Passport size (Six) (b) Stamp size 2. Name of the Student : _________________________________________________________________________________________ Name of the Father / Parent / Guardian: ___________________________________________________________________________ Residential address : ___________________________________________________________________________________________ Specifically Declarations (10 & 22) is being reproduced hereunder : Declaration 10 : In addition to the above. I/We further declare that the above named student is taking admission in the ____________________________________________ ___________________________________________________(course opted for) having considered everything material and on his/her own sweet will and with the permission of the Father / Mother / Legal Guardian without any coercion from any side. Admission Test / FTRE / FTSE / Fortunate . neither is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. JEE is a different exam where you will feel lost if you do not focus on fundamentals and/or you do not develop / have high analytical skills. students / parents must clearly understand this important aspect and take admission only if they are fully satisfied. (b) It is advised that student undergoes a comprehensive Medical Examination to ensure that he/she is physically & mentally fit to take the rigors of preparing for a competitive exam including but not limited to JEE (Advanced) & JEE (Main) etc. Furthermore. 2. faculty & other resources about 6 months before commencement of financial year. Since FIITJEE has to source infrastructure.FIITJEE students both successful in IIT & the unsuccessful ones.e. whether it happens or not will depend upon you. FIITJEE admits students as per its capacity plans. policies pertaining to the courses of competitive exam such as JEE (Main) / JEE (Advanced). An intelligent student having aptitude & analytical skills for JEE / NTSE etc has to have self study for at least 3 hrs. the teachers feel that the student is not working hard. However. FIITJEE shall take all necessary steps to protect the interest of students. Needless to say if you have not been a highly analytical student you have to put in even greater efforts. he/ she may be expelled from the institute. NTSE etc & learn what made them successful. Admission at FIITJEE does not mean that you have high analytical skills. it is also important to have excellent performance In XII Board Exams.Enrolment Form Important Information for Students (and their parents / legal guardians) 1. Ultimately above student who is enrolled with institute will have to continuously work hard and must be regular in studies. FIITJEE teachers will guide you in such a way that your fundamentals are strengthened and you can improve your analytical skills tremendously. The only way to develop strong fundamentals & improve your analytical skills & therefore your chances to get through JEE (Main) / JEE (Advanced) / NTSE. Preparing to achieve optimum performance in both Boards & JEE will challenge every bit of your mental & physical energies. Therefore. regulations. Not all students who sit in our admission test are offered admission therefore you & parents have to be very sure before taking admission as you have to pay complete fee under all circumstances. For success in JEE. Please do not take admission at FIITJEE if you think FIITJEE is not the best for JEE coaching. etc with excellent School / Board performance is to solve each & every problem in FIITJEE assignments yourself. NTSE etc. 3. Any amount of effort will be in vain without high analytical skills. FIITJEE starts making arrangements of infrastructure. (c) Meet few FIITJEE students successful in IIT-JEE / AIEEE {now JEE (Advanced) & JEE (Main) respectively}. Student’s Signature Name : _________________________________ Date : __________________________________ Place : __________________________________ Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________ 9 . is creating indiscipline in the Institute. Olympiads. No fee or part of the fee will be refunded in such case. as the case may be.Each Candidate. any vacancy created by a student leaving cannot be filled up. selection letter & website thoroughly. We highly advise that you also talk to Non . to form a clear opinion regarding what a coaching institute can do for you. You may have to make several attempts & even go back to your basics to refresh them to solve a particular problem. even if he/she discontinues for any reason whatsoever or parents / guardians be transferred. Any change in government rules. The decision of FIITJEE in this regard will/shall be final and binding on the students. remember while anyone can appear in JEE (Main) / JEE (Advanced) or pretend to prepare but only the ones who walk the right path succeed. (subject to unforeseen circumstances & usual organizational risks) therefore each student taking admission has to pay complete fee under all circumstances i. faculty etc. in advance. Once a class starts FIITJEE does not admit any students. (a) Before Taking Admission . is irregular in attendance or is not responding properly. for every hour taught at FIITJEE. His/Her Parents & Legal Guardians are required to Go through the FIITJEE Leaflet / Brochure / Information Booklet. word of advice. which may render these exams as deleted or cancelled in such eventuality. FIITJEE shall not be held responsible in any manner whatsoever. KVPY. It is this intensity & quality of effort which will help you develop good analytical skills. Therefore. Other than these no other verbal assurance of any kind is given by FIITJEE. In case. In the end. loss of fees of students leaving after taking admission will compel the institute to enhance fees for next batch of students which is unfair to them. FIITJEE has no magic potion to make you successful. What was the contribution of FIITJEE in their success? Also meet a few FIITJEE students not successful in IIT-JEE / AIEEE {now JEE (Advanced) & JEE (Main) respectively} / NTSE & learn why they could not qualify IIT-JEE / AIEEE {now JEE (Advanced) & JEE (Main) respectively} / NTSE. 13. at any stage of my association with FIITJEE. 2. FIITJEE has enjoyed great relationship with the students and parents. In few cases where some students do discontinue because they are not able to cope up with simultaneous competitive exam preparations along with school / board studies. the decision of the Management of FIITJEE shall be final and binding in all circumstances and situations. However. extensive study. I am taking admission in FIITJEE with the consent of my Father / Mother / Legal Guardian and after being satisfied in all respects. I understand without any ambiguity that the fee once paid is not refundable at all. FIITJEE may not allow me to attend the classes. I/We understand and acknowledge that preparation for JEE requires exhaustive hard work. I further undertake that I shall not make copies of the study material provided by the FIITJEE nor shall provide / give / distribute it to anyone else. 9. 8. In addition to the above. whatever the reasons be. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option (the same is signed by me & the student and is attached with this enrolment form) at our own sweet will and convenience without any pressure / coercion from any one. inspite of providing the best teaching faculty and methodology. will do goal refocusing for all Two Year Classroom Program students including PINNACLE program students to help each student achieve maximum possible success. FIITJEE may take any legal action against me/us which FIITJEE may deem fit including but not limited to my (student) expulsion from the institute and I/We shall not be entitled for any refund of fees / claim / compensation / damages etc. already paid on ground of inability to furnish/complete documents / formalities. 16. I/We have fully satisfied ourselves with regards to quality and excellence of teaching at FIITJEE from all available information / sources and have decided to study only at FIITJEE. I/We further undertake that I/We shall not claim any refund of fees/ cost of study material etc.. I undertake that I shall follow the rules and teaching methodology beside study and practice rigorously without loosing self-confidence. 3. the parents have continued to support the good work of FIITJEE. 4. nor is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. including but not limited to transfer of my Father / Mother / Legal Guardian / ill health of myself or any other member of the family or my admission in any institute / course / engineering college etc. Student’s Signature Name : _________________________________ Date : __________________________________ Place : __________________________________ Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________ 10 . then the said teacher will be considered to teach below the minimum FIITJEE Standard. 14. If a teacher gets less than 70% feedback in two consecutive periods then his/her teaching will be considered unsatisfactory by high FIITJEE standards. 5. 15. 10. It is understood that this admission is valid only for the course and the duration for which I am taking admission and I/We (the student and the Parents / Legal Guardian) shall not claim / request for admission to and adjusting the fees to any other course or duration. 7. However if I fail to do so. may have to predominantly focus on exams other than JEE (Main & Advanced). I/We clearly understand that FIITJEE on completion of topics to be covered by FIITJEE in Class XI as per it’s plan. is correct to the best of my knowledge and belief. I/We understand and acknowledge that FIITJEE does not give any guarantee / promise / assurance for success in JEE (Main) / JEE (Advanced) / XII boards. it may consider my request for change of program subject to payment of difference of course / program fee.. whatsoever. I/We undertake that I/We shall furnish / submit / complete the remaining required documents and formalities by at least two days prior to commencement of course program. What will constitute deficiency in service? If the average feedback of the particular subject teacher goes below 70% in the Feedback Form “Annexure . I or my Father / Mother / Legal Guardian shall not be entitled for refund of fees. or my studentship is cancelled because of misconduct etc. motivation and self confidence. I/We undertake that the information / details furnished / given by me/us are correct and if any discrepancy is found in the said details / information. This means that some students based on their performance. I/We acknowledge that the course materials provided to the student by FIITJEE during the course of study at FIITJEE are the intellectual property of FIITJEE and solely for personal purposes and not for commercial use. I undertake that I shall abide by the rules & regulations of FIITJEE or FIITJEE’s associated schools. I/We hereby declare that the information furnished on this enrolment form etc. if the following declarations are not agreeable to you Please read the Declarations / Undertakings carefully before signing Declaration: 1.FB” (attached herewith). I/We agree to submit a photocopy of the JEE Admit Card of the student by 25th March of the concerned JEE year to FIITJEE and admit card of various Other Engineering Entrance Exam as soon as I/We receive the same from the examining body. if FIITJEE finds me competent / eligible for the higher course / program. due to high-end competition and limited number of seats in IIT. I undertake that I shall not hold FIITJEE responsible if I may not crack the JEE or other competitive exam. 6. I undertake that if I leave the institute midway before completing the full course for any reason whatsoever.Enrolment Form DECLARATIONS / UNDERTAKINGS Kindly do not take admission at FIITJEE. 12. unless otherwise allowed by the FIITJEE in writing. Almost all students in every class and every program have been succeeding in coping up with huge pressure of simultaneous preparation for competitive exams along with school / board studies. I/We shall not be entitled to change the study centre / program nor will I be entitled to refund of fees. 11. I/We undertake that once I (student) join the study centre / program offered by FIITJEE. I undertake that in case of any dispute relating to breach / violation of any of the Rules & Regulations of FIITJEE or FIITJEE’s associated school. I shall inform the relevant court / forum regarding this jurisdiction constraint. The venue of Arbitration shall be Delhi / New Delhi only. 18. or its sister concern. from FIITJEE and shall refund / return such Awards / Rewards / Scholarships / Benefits etc.. I further undertake to endorse the efforts and contributions made by FIITJEE In achieving the rank while giving Interviews to the media (print / electronic / web).Enrolment Form DECLARATIONS / UNDERTAKINGS 17. I know that registered office of FIITJEE Ltd. I/We further declare that the student named on page no. 28. Subject to clause 27 above. if the investigating committee concludes that student had not secured the scholarship on his / her own merits. I/We shall not be entitled for any Awards / Rewards / Scholarships / Benefits etc.. It is further agreed that in spite of the fact that the Sole Arbitrator may be known to any of the Directors or share holders and that he may have been dealing with the Company or had occasion to deal with any matter of this agreement shall not disqualify him. I/We further undertake that I/We shall attend the seminars / workshops / felicitation / interview etc. I promise to abide by all rules and regulations of FIITJEE declaration. Further I/We understand that the student is required to work hard to attain the average standard of the batch allotted in order to cope up with studies and put in extra efforts if lagging behind in any subject / topic. conducted by FIITJEE after achieving rank by the student. if your child has got scholarship using unethical means please do not take admission at FIITJEE. I/We undertake that I / we shall / will fully cooperate to achieve this objective including giving the JEE Admit Card before 25th March of the concerned JEE year and signing the letter of appreciation lauding FIITJEE efforts. If availed by the student. In the event of any dispute between the parties regarding the interpretation of clauses of enrolment form or any claim etc. Parents and Guardians of the student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and also a compensation of Rs. on his/her own sweet will after giving due consideration to rigors of time. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further agree to give a letter of appreciation to FIITJEE for the outstanding result in form of a Letter. 3 is taking admission in the program as mentioned on page 3 having considered everything material. If a student is awarded scholarship by FIITJEE and does not perform at a similar level after joining FIITJEE Classroom / Integrated School Program then a probe may be lodged to find out if the student got scholarship on his / her own merit or by using any unfair means. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word of mouth among the students. I’ll fully abide by the rules and regulations of the school. and for reasons of having any prior linkage with the company. “C” & “D” for my future reference and timely compliance. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. however the FIITJEE shall alone bear the entire cost and expenses in respect thereof. In case I do. FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student / parents / legal guardian will have no objection for the same. I/We further undertake to ensure that cheques / drafts including post dated cheques if any given by us will be honored by our bankers. within a period of 15 days. 29. I/We further undertake that I/We shall compensate for/ indemnify against any loss /damage caused to FIITJEE. “B”. the matter shall be referred to the Sole Arbitrator appointed by FIITJEE Ltd. I/We undertake that I (student) shall not indulge in any illegal / unethical / unprincipled / immoral / corrupt / dishonest activities which may cause loss of property. I / We (Student and the parent) am/are joining FIITJEE’s Integrated School Program only after satisfying myself / ourselves about the structure of program. I have kept a photocopy of all the pages of this enrolment form including this declaration and Annexures “A”. is situated at New Delhi. FIITJEE is at liberty to initiate any action against us including legal proceedings under section 138 of Negotiable Instruments Act or other appropriate law. Additional declaration for Integrated School Program Students only : 30. 27. 19. distance and studies ahead and with the permission of the Father / Mother / Legal Guardian without any coercion from any side. In the event of these cheques/drafts being dishonored. hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form. Even if the Arbitrator may have expressed opinion in similar matter earlier shall also not render him disqualified. Student’s Signature Name : _________________________________ Date : __________________________________ Place : __________________________________ Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________ 11 . in letter and spirit. failing which FIITJEE shall be entitled to recover the same from the appropriate court / forum alongwith interest. 25. 20. I/We (the student and the Father / Mother / Legal Guardian) understand that in case of any legal dispute. arising out of taking the admission in FIITJEE Ltd. 26. the jurisdiction will be an appropriate court/forum in Delhi / New Delhi only and I/We shall not take recourse to such an action in any other court / forum or anywhere else. I/We undertake and acknowledge that incase I/We indulge in any kind of litigation with the FIITJEE. damages and cost of litigation. I have read the above carefully and have understood it clearly. I/We. The decision of the arbitrator shall be final & binding on both parties. reputation and goodwill of FIITJEE. I also understand that in the event I am expelled from the school on any disciplinary ground I’ll raise no claim from FIITJEE for any academic and/or financial loss including course fee. 24. 22. Annexure and Declarations and agree to abide by them without any reservation or ambiguity. If we fail to give the JEE admit card by 25th March of the concerned JEE year. a Video Interview or any other forum / format that FIITJEE deems fit. Therefore. the parent / guardian and/or the student. The arbitration proceedings shall be conducted in accordance with the provisions of the Arbitration & Conciliation Act. 21. 23. I/We have also read the current FIITJEE Brochure carefully and have understood it clearly. 1996 and statutory modification thereof & rules made thereunder. 10 Lacs. Date : _________________________________ Place : _________________________________ Student’s Signature : ________________________________ Name : _______________________________________________ (To be struck off. Date : _________________________________ Place : _________________________________ Student’s Signature : ________________________________ Name : _______________________________________________ (To be struck off.Enrolment Form DECLARATIONS / UNDERTAKINGS (Declaration to be given by the student if Father / Mother / Legal Guardian does not reside in the Study Centre City. B. charges duly calculated and collected. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities in writing. o Cash scholarship (If any) : _______________________________________________________________________________ o Fee Waivers offered (If any) : ___________ % on ____________________________________________________ ground o Hostel fee waiver (If any) : ______________________________________________________________________________ The certificates pertaining to scholarship are attached. my admission shall be liable to be cancelled and I or my Father / Mother / Legal Guardian shall have no claim for refund of fees or any other compensation of any type. I own all responsibility on their / his / her behalf. if Not Applicable) For Office use only Check list for the Accountant / Admission Coordinator. v v v v v v v Declaration by the Accoutant / Admission Coordinator. Date : _______________________ Place : _________________________ 12 Signature of the Account / Admission Coordinator . Signatures on PDCs and on Annexure B and C are same. v v v Name of the Accountant / Admission Coordinator : _____________________________________________________________ The Application form is complete in all respect with Annexure A. The student has been offered the admission after selection in Admission test only. The details of the scholarship offered. The fee charged has been duly matched and verified with the fee brochure. The Enrolment is recommended. C and D duly signed by the student and the parent. Is the student joining as a Hosteller? If yes details of the Local Guardian are provided. neither does he/she have any Local Guardian) As my Father / Mother / Legal Guardian do(es) not reside at _______________________________________ and I have no Local Guardian. Late payment charges / Admin. I have verified the entire Enrolment form and checked all the points mentioned above. which I shall send to my Father / Mother / Legal Guardian and submit to FIITJEE within 15 days with his/her signatures. if Not Applicable) (Declaration to be given if the Enrolment form is not signed by the Father / Mother / Legal Guardian at the time of admission) I have received an extra copy of this Enrolment Form. 6 passport size and one stamp size photograph are attached. Sunday Contact Classes 6051 6053 Please affix the 2nd passport size colour photograph of the student here Program Code For Admission in Class 7th UDAYA Plus .One Year Foundation Program .Four Year Integrated School Program for JEE (Main) Four Year Classroom Program for JEE (Advanced) .Enrolment Form Classroom / Integrated School Programs Program Name For Admission in Class 6th Little Genie .Four Year Integrated School Program for Admission to World’s Top Universities Four Year Classroom Program for Admission to World’s Top Universities 9020 9022 9061 9062 9063 9071 9072 9073 9021 9042 Please submit 3 additional passport size colour photographs with this Enrolment Form For Admission in Class 10th Three Year Classroom Program for IIT-JEE .Sunday Contact Classes Three Year Classroom Program for Admission to World’s Top Universities 1061 1062 1063 1042 13 .Regular Week Contact Classes Four Year Classroom Program for JEE (Main) .Two Year Classroom Program .Four Year Integrated School Program for JEE (Advanced) ATHENA .Two Year Integrated School Program UDAYA .Weekend Contact Classes UDAYA .Regular Week Contact Classes UDAYA .Sunday Contact Classes LIBERTY .Weekend Contact Classes Four Year Classroom Program for JEE (Main) .Sunday Contact Classes 7010 7051 7052 7053 Please affix the 3rd passport size colour photograph of the student here For Admission in Class 8th UDAYA .Two Year Classroom Program .Weekend Contact Classes UDAYA .One Year Foundation Program .Regular Week Contact Classes Three Year Classroom Program for IIT-JEE .Sunday Contact Classes Four Year Classroom Program for JEE (Main) .Weekend Contact Classes Four Year Classroom Program for JEE (Advanced) .Two Year Classroom Program .Sunday Contact Classes 8051 8052 8053 Please affix the stamp size colour photograph of the student here For Admission in Class 9th Supreme .One Year Classroom Program .Regular Week Contact Classes Little Genie .Weekend Contact Classes Three Year Classroom Program for IIT-JEE .Regular Week Contact Classes UDAYA .Regular Week Contact Classes Four Year Classroom Program for JEE (Advanced) .One Year Classroom Program .One Year Classroom Program . Weekend Contact Classes One Year Classroom Program for JEE (Advanced) .Sunday Contact Classes Two Year Classroom Program for JEE (Advanced) .Regular Week Contact Classes One Year Classroom Program for JEE (Advanced) .Sunday Contact Classes One Year Classroom Program for JEE (Advanced) .Regular Week Contact Classes One Year Classroom Program for JEE (Advanced) .Regular Week Contact Classes Special Classroom Program (for Ex-FIITJEEians) Intensive Contact Program for IIT-JEE Super Rank Enhancement Classroom Program for IIT-JEE Crash Course for JEE (Main) 1351 1371 1361 1362 1381 1382 1386 14 .Weekend Contact Classes Two Year Classroom Program for JEE (Advanced) .Regular Week Contact Classes One Year Classroom Program for JEE (Main) .Regular Week + Sunday Contact Classes Two Year Classroom Program for JEE (Main) .One Year Classroom Program Special Weekend Classroom Program for IIT-JEE Intensive Contact Program for IIT-JEE Super Rank Enhancement Classroom Program for IIT-JEE Crash Course for JEE (Main) 1251 1252 1253 1254 1271 1272 1273 1278 1242 1262 1281 1282 1286 For Admission After Class 12th One Year Extended Classroom Program for JEE (Advanced) .Weekend Contact Classes Two Year Classroom Program for JEE (Main) .Weekend Contact Classes One Year Classroom Program for JEE (Main) .Sunday Contact Classes One Year Classroom Program for JEE (Main) .Regular Week Contact Classes Two Year Classroom Program for JEE (Main) .Regular Week Contact Classes One Year Classroom Program for JEE (Main) .Two Year Integrated School Program for IIT-JEE Two Year Classroom Program for JEE (Advanced) .Regular Week + Sunday Contact Classes One Year Classroom Program for JEE (Main) .Sunday Contact Classes GOLDEN BRIDGE .Regular Week + Sunday Contact Classes USA UnivQuest .Special Weekend Contact Classes Two Year Condensed Classroom Program for IIT-JEE -Regular Week Contact Classes Two Year Condensed Classroom Program for IIT-JEE -Weekend Contact Classes Two Year Condensed Classroom Program for IIT-JEE .Special Weekend Contact Classes Two Year Classroom Program for JEE (Advanced) .Two Year Integrated School Program for Admission to World’s Top Universities Two Year Classroom Program for Admission to World’s Top Universities 1110 1151 1152 1153 1154 1155 1171 1172 1173 1174 1161 1162 1163 1141 1142 Program Code For Admission in Class 12th One Year Classroom Program for JEE (Advanced) .Enrolment Form Classroom / Integrated School Programs Program Name For Admission in Class 11th Pinnacle .Sunday Contact Classes Two Year Classroom Program for JEE (Main) .Regular Week Contact Classes Two Year Classroom Program for JEE (Advanced) . FIITJEE School Network Delhi (South) Delhi (Punjabi Bagh) Delhi (East) Noida (Delhi-NCR) Gurgaon (Delhi-NCR) Chandigarh Lucknow Jaipur Gwalior Bhopal Vadodara Indore Nagpur Mumbai (Kandivali) Mumbai (Chembur) Pune Bokaro Bhilai Raipur FIITJEE Junior College Visakhapatnam FIITJEE Junior College Vijayawada Chennai (Adyar) Chennai (Kilpauk) Chennai (Sriperumbudur) Chennai (KK Nagar) Andaman and Nicobar Faridabad (Delhi NCR) Ghaziabad (Delhi-NCR) Kanpur Allahabad Gorakhpur Varanasi Patna Kolkata Bhubaneswar Ranchi FIITJEE Junior Colleges Hyderabad (Saifabad) Hyderabad (Dilshukhnagar) Hyderabad (Kukatpally) Kochi Coimbatore FIITJEE Associate Schools FIITJEE Junior Colleges * This map is not to scale Bangalore Lakshadweep (India) . New Delhi .fiitjee.L.46106000 /10 /13 /15 All India Toll Free No. : 011 .N.com Enrolment Form w. 11th November. : 1800 11 4242 Fax : 011 .FIITJEE Centre Network Delhi (South) Chandigarh Delhi (Punjabi Bagh) Delhi (East) Meerut Amritsar Lucknow (Gomti Nagar) Lucknow (Aashiana) Gorakhpur Delhi (Rohini) Delhi (Janakpuri) Delhi (Dwarka) Noida (Delhi-NCR) Gurgaon (Delhi-NCR) Faridabad (Delhi-NCR) Ghaziabad (Delhi-NCR) Jaipur (J.26513942 Web : www. Marg) Jaipur (Vaishali) Kanpur Allahabad Gwalior Indore Vadodara Nagpur Bhopal Varanasi Patna Dhanbad Bokaro Kolkata (Rabindra Sadan) Kolkata (Ultadanga-Salt Lake) Durgapur Ranchi (Lalpur) Ranchi (SOP Doranda) Raipur Bhilai Shaktinagar NTPC Andaman and Nicobar Mumbai (Dadar) Mumbai (Chembur) Mumbai (Kandivali) Mumbai (Andheri) Mumbai (Navi Mumbai) Mumbai (Thane) Pune Hyderabad (Saifabad) Hyderabad (Dilshukhnagar) Hyderabad (Kukatpally) Bangalore Kochi Lakshadweep (India) Bhubaneswar Visakhapatnam Vijayawada Chennai (Nungambakkam) Chennai (Kilpauk) Chennai (Adyar) Chennai (Sriperumbudur) Chennai (KK Nagar) Coimbatore * This map is not to scale L I M I T E D National Admissions Office : FIITJEE House. Sarvapriya Vihar. Kalu Sarai.110 016 Ph.e. 29-A. 2012 .f.