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Please AffixYour RecentPassport SizeColour Photograph Name of the Candidate :Father's/Guardian's Name :Date of Birth : Nationality : C orrespondence Address : School affiliated to : CBSE ICSE Others (Please Specify)Class : VIIVIII IXXIXIIXII (pass)Marks in Sc + Math / PCM (%) Obtained :X Board.%XII Board.%Marks (if in Grades ) :X Board - ScienceMathsXII Board - PCMCategory of Student :General Others (Please specify) _________________________ E-mail ID of the Student : D DM MY Y Y Y ENROLMENT FORM (For official use only) Enrolment No. :Name of Program Enrolling for :Preference of Test Centrefor AITS for IIT-JEE / AIEEE++ : PinPinMobile No :Mobile No :Ph. (Res.) with STD Code :Ph. (Res.) with STD Code :Permanent Address : 1/4 FIITJEE Limited , FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com Correspondence Programs (To be filled by the student) Please mention your Enrolment No. in case you are already enrolled in any other FIITJEE program : (For list of test centres see page 2) ** Nearest relative / Guardian Address (to be contacted in case the candidate is not available at the above mentioned addresses) :Ph. Mobile No:School Address (studying or passed):Phone. :(Res.) with STD Code :PinPinCHECK LIST 1. Photocopy of X / XII board marksheet*VI school final exam marksheet (for Target NTSE in The Box Two Year Program)VII school final exam marksheet (for Target NTSE in The Box One Year Program)VIII school final exam marksheet (for ASCENT in The Box)2. Photographs colour (3 passport & 1 stamp size)3. Demand Draft for course fee* In case of claim for scholarship in Rankers Study Material program the X / XII marksheet / NTSE certificate is to be attested by the past or present school Principal. ** Please mention if you want to recieve information through SMS on this mobile: 2/4 Delhi (South), Delhi (North-West), Delhi (East), Delhi NCR (Gurgaon), Delhi NCR (NOIDA), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai,Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Coimbatore, Dehradun, Dhanbad, Durgapur, Gorakhpur, Guwahati, Gwalior,Hisar, Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota,Lucknow, Ludhiana, Meerut, Mumbai (Kandivali), Mumbai (Sion), Mumbai (Thane), Muzzafarpur, Nagpur, Patiala, Patna, Pune,Ranchi, Rohtak, Roorkee*, Rourkela, Shakti Nagar NTPC, Siliguri, Thrissur, Trivandrum, Udaipur, Ujjain, Vadodara, Varanasi,Vijayawada & Vishakapatnam. $ TEST CENTRES FOR ALL INDIA TEST SERIES (AITS) for IIT-JEE, 2012 / 2013 : (Only one centre can be opted.) Note : All India Test Series (One Year & Two Year) and All India Test Series for AIEEE++ (One Year & Two Year)is also available by Correspondence (All the Test Papers to be received & attempted at your home.) $ Above are the test centres for All India Test Series for IIT-JEE only. ( For centres of Concept Strengthning & Analysis Program (CSAP), please contact your nearest FIITJEE Centres.) * Roorkee is the test centre only for Open Test. Course Fee payment details : Demand Draft No. Drawn on Bank Dated Amount FIITJEE Limited , FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com Delhi, Allahabad, Amritsar, Bangalore, Bathinda, Bhilai, Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dhanbad, Durgapur,Hyderabad, Indore, Jaipur, Jamshedpur, Kanpur, Kolkata, Kota, Lucknow, Mumbai, Muzaffarpur, Nagpur, Patna, Pune, Ranchi,Rourkela, Shakti Nagar NTPC,Vadodara, Varanasi & Vishakapatnam. TEST CENTRES * FOR ALL INDIA TEST SERIES for AIEEE++, 2012 / 2013 : (Only one centre can be opted.) * Open Test for AIEEE++ will be held at all centres of All India Test Series for IIT-JEE / AIEEE++. YesNo 3/4 Note 1 : Fee of any program is not refundable at any stage. Note 2 : All India Test Series is part of Rankers Study Material. You need not enrol for it separately in case you are enrolling yourself for Rankers Study Material. Note 3 : All India Test Series for AIEEE++ is a part of Correspondence Course for AIEEE++. You need not enrol for it separately in case you are enrolling yourself for Correspondence Course for AIEEE++. Note 4 : Please write your name behind your photograph and your name & address behind the demand draft. Note 5 : The Demand Draft for course fee for all the above mentioned IIT-JEE programs except Open Test should be in favour of FIITJEE LIMITED - TS, RTPF, GMPA/c payable at New Delhi. In case of Open Test the draft should be in favour of “FIITJEE LIMITED Open Test, Aptitude Test etc. A/c” payable at New Delhi. Note 6 : Demand Draft for course fee of Correspondence Course for AIEEE++ (One / Two Year Version) / One Year All India Test Series for AIEEE++ / Two Year Integrated All India Test Series for AIEEE++ should be in favour of “ FIITJEE Ltd - ASM A/c ” payable at New Delhi. Note 7: Photocopy of this form can also be used. Place: __________________ (Signature of the Student) (Signature of the Parent / Guardian)Date: _______________ Name ________________________________________ Relationship with the student _____________________ FIITJEE Limited , FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com For students of class IX aspiring to excel in IX, X, I am interested in enrolling for (Tick the appropriate box) Jr. Science Olympiad / Math Olympiad &Foundation IIT-JEE / KVPY / Other Competitive Exams Jr. Rankers Study Material For IIT-JEE, 2013 I am interested in enrolling for (Tick the appropriate box)Rankers Study Material (Two Year Version) Two Year Integrated All India Test SeriesTwo Year Integrated All India Test Series (By Correspondence) All India Test Series (for Class XI only) Rankers Study Material (One Year Version) One Year All India Test SeriesOne Year All India Test Series (By Correspondence) For IIT-JEE, 2012 I am interested in enrolling for (Tick the appropriate box) For AIEEE, CET(Karnataka) CET(GGIPU) & BVP (PUNE), WBJEE, BCECE etc., 2012 I am interested in enrolling for (Tick the appropriate box)One Year All India Test Series for AIEEE++ 4/4 2 6 0 4 1 1 FIITJEE Limited , FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com Jr. Rankers Study Material :30th September, 2011 Last date to receive completed applications for following program for students aspiring to excel inIX, X, Jr. Science Olympiad / Math Olympiad & Foundation IIT-JEE / KVPY / Other Competitive Exams Rankers Study Material (Two Year Version) : 20th September, 2011Two Year Integrated All India Test Series: 18th November, 2011Two Year Integrated All India Test Series: 25th November, 2011 (By Correspondence) All India Test Series (for Class XI only) : 18th October, 2011 Last date to receive completed applications for following programs for IIT-JEE, 2013 Mailing commences from April, 2011 Rankers Study Material (One Year Version) :31th August, 2011:One Year All India Test Series :10th October, 2011:One Year All India Test Series (By Correspondence) :17th October, 2011 Last date to receive completed applications for following programs for IIT-JEE, 2012 Despatches are done fortnightly to all new enrolments. One Year All India Test Series for AIEEE++:23rd October, 2011 Last date to receive completed applications for following programs for AIEEE++, 2012
