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En r o l m e n t F o r m

(for Classroom / Integrated School Programs)

Enrolment Number (for official use only)

Instruction for filling Enrolment Form


Please read carefully the Important Information for Students (& their Parents / Legal Guardians) and Declarations / Undertakings section on page no. 9, 10 & 11 respectively before filling this Form.

Please Note :
v Check the availability of the program at your preferred FIITJEE centre before making a choice. v Make a photocopy of this form after filling the required information and before submitting it to FIITJEE. v Log on to www.fiitjee.com/regupdate.htm to update your Contact Details online using Registration Number and web access code printed on your Hall Ticket.

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, Two on page no. 13 and Three photographs should be submitted along with this Enrolment Form). v One stamp size photograph (should be pasted on page no. 13). v Admission Test / FTRE / FTSE / Fortunate - 40 Hall Ticket (in Original). v Admission offer letter (in Original). 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 students photograph Original should be presented for verification at the time of admission.

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. 13 & 14) Scholarship Awarded % (if applicable) : _________________________________________________________

: ________________________________________________________________________ : ________________________________________________________________________ : ________________________________________________________________________

Students 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. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________

School/College Last Attended / Presently Attending : _____________________________________________________________________ Address : _______________________________________________________________________________________

_________________________________________________________________________________ Pin : _________________________________

(a) Fathers Name Occupation :

Business 

: ________________________________________________ Qualification : _________________________ Govt. Service  Pvt. 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) Mothers Name Occupation : Business 

: ________________________________________________ Qualification : _________________________ Govt. Service  Pvt. 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 : ___________________________


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Enrolment Form

(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler)
Local Guardians Name Occupation : Business  : ________________________________________________ Qualification : ________________________ Govt. Service  Pvt. 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. Name Class studying in

(if applicable)

: _______________________________________________________________________________________ : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________

2. Name Class studying in

: _______________________________________________________________________________________ : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________

3. Name Class studying in

: _______________________________________________________________________________________ : ___________________________ Enrolment No. (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)

II

III

: _______________________________________

Detail(s) of Demand Draft(s) / Pay Order(s) S. No.


1 2 3 4 Total

Instrument Number

Dated

Issuing Bank & Branch

Amount (in Rs.)

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, 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, therefore I understand that FIITJEE 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 arrangement, for below stated Post Dated Cheque(s), to get honoured, and will keep sufficient funds on or before the due date for the same. Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted) S. No.
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. parents / guardian

Cheque No.

Dated

Issuing Bank

Fee Amount

S. Tax Amount

Total Amount

I further agree to get above Post Dated Cheque(s) cleared, even if, my son / daughter / ward discontinues studies at FIITJEE, irrespective of any reasons. I am signing the above declaration in good mental / physical health. I have satisfied myself about FIITJEE. The necessary Enrolment-Forms, 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. 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 Guardians 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. Date : _________________________________ Place : _________________________________
5

Father / Mother / Legal Guardians Signature Name : ______________________________________

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), submitted for payment of fees (on installment basis) as mentioned in the Enrolment-Form and annexure B is punishable under Sec. 138 (B) of the Negotiable Instrument Act. I understand that FIITJEE 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 FIITJEE. In case any of my Post Dated Cheque(s) bounces for any reason whatsoever, I undertake to submit a DD/Pay-Order in favour of FIITJEE Ltd. 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 alongwith late payment of Rs. 50/- (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.

Signature of the Student

Name : ____________________________________________________ Enrolment Number (for office use only) : __________________________

Father / Mother / Legal Guardians 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.

Date : _________________________________ Place : _________________________________

Father / Mother / Legal Guardians Signature Name : ______________________________________

Enrolment Form

Annexure C PARENT DATA SHEET


(CONFIDENTIAL) Dear Parent / Guardian, 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. This information will be confidential.

1. Name of the Student 2. Fathers/Guardians Name 3. Relation with Student

: ______________________________________________________________________________ : ______________________________________________________________________________ : ______________________________________________________________________________

4. 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. What is the students class rank? : ____________________________________________________________________________ 7. Some gifted individuals make mediocre scholastic records. Is the students record an accurate index of his/her capabilities? Yes / No If no, state why? : ______________________________________________________________________________

8. What is the students biggest weakness? : ______________________________________________________________________ 9. Have there been any major changes in the students attitude towards studies till now at any time, if so illustrate, when and why?
(You may attach a blank page if required.)

10. Please mention any other information relating to the student, which help make FIITJEE understand the student better. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health to successfully cope up & complete his/her studies at FIITJEE and fulfill all terms & conditions.

Father / Mother / Legal Guardians Signature

Date : _________________________________ Place : _________________________________

Enrolment Form

Annexure D
Kindly do not take admission at FIITJEE if the clauses of the declaration on the Enrolment Form on page no. 10 & 11 is not agreeable to you. Name of the Student : _________________________________________________________________________________________ Name of the Father / Parent / Guardian: ___________________________________________________________________________ Residential address : ___________________________________________________________________________________________ Specific Declarations (10 & 22) are being reproduced hereunder : Declaration 10 : In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be, 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. Declaration 22 : I/We, the parent / guardian and/or the student, hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form, Annexure and Declarations and agree to abide by them without any reservation or ambiguity. 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.

Signature of the Student

Father / Mother / Legal Guardians 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.

Date : _______________________________

Place : _____________________________

Father / Mother / Legal Guardians Signature

Instruction : After filling-up annexure A, B, C & D please retain photocopy of the same before submitting at the FIITJEE

Checklist :

1. Demand Draft(s) / Pay Order(s) for the fee 2. Local / at par post dated cheque(s) 3. Enrolment Form duly filled in 4. Annexure A to D 5. Colour Photographs: (a) Passport size (Six) (b) Stamp size 2.5 x 2 cm. (One)

   

   

6. Admission Test / FTRE / FTSE / Fortunate - 40 Hall Ticket (in Original) 7. Admission offer letter (in Original) 8. 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 students photograph

   

Enrolment Form

Important Information for Students (and their parents / legal guardians)


1. Before Taking Admission - Each Candidate, His/Her Parents & Legal Guardians are required to (a) Go through the FIITJEE Leaflet / Brochure / Information Booklet, word of advice, selection letter & website thoroughly. Other than these no other verbal assurance of any kind is given by FIITJEE. (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. as the case may be. (c) Meet few FIITJEE students successful in IIT-JEE / AIEEE {now JEE (Advanced) & JEE (Main) respectively}, NTSE etc & learn what made them 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. We highly advise that you also talk to Non - FIITJEE students both successful in IIT & the unsuccessful ones, to form a clear opinion regarding what a coaching institute can do for you. Please do not take admission at FIITJEE if you think FIITJEE is not the best for JEE coaching. An intelligent student having aptitude & analytical skills for JEE / NTSE etc has to have self study for at least 3 hrs. for every hour taught at FIITJEE. Needless to say if you have not been a highly analytical student you have to put in even greater efforts. For success in JEE, it is also important to have excellent performance In XII Board Exams. Furthermore, 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. Any amount of effort will be in vain without high analytical skills. Admission at FIITJEE does not mean that you have high analytical skills. FIITJEE teachers will guide you in such a way that your fundamentals are strengthened and you can improve your analytical skills tremendously, whether it happens or not will depend upon you. The only way to develop strong fundamentals & improve your analytical skills & therefore your chances to get through JEE (Main) / JEE (Advanced) / NTSE, etc with excellent School / Board performance is to solve each & every problem in FIITJEE assignments yourself. You may have to make several attempts & even go back to your basics to refresh them to solve a particular problem. It is this intensity & quality of effort which will help you develop good analytical skills. Ultimately a student who is enrolled with institute will have to continuously work hard and must be regular in studies. In case, the teachers feel that the student is not working hard, is creating indiscipline in the Institute, is irregular in attendance or is not responding properly, he/ she may be expelled from the institute. The decision of FIITJEE in this regard will/shall be final and binding on the students. No fee or part of the fee will be refunded in such case. In the end remember, while anyone can appear in JEE (Main) / JEE (Advanced) or pretend to prepare but only the ones who walk the right path will succeed. FIITJEE has no magic potion to make you successful. Preparing to achieve optimum performance in both Boards & JEE will challenge every bit of your mental & physical energies. 2. FIITJEE starts making arrangements of infrastructure, faculty & other resources about 6 months before commencement of financial year. FIITJEE admits students as per its capacity plans, (subject to unforeseen circumstances & usual organizational risks) therefore each student taking admission has to pay complete fee under all circumstances i.e. even if he/she discontinues for any reason whatsoever or parents / guardians be transferred. 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. Once a class starts FIITJEE does not admit any students. Therefore, any vacancy created by a student leaving cannot be filled up. Since FIITJEE has to source infrastructure, faculty etc. in advance, 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. Therefore, students / parents must clearly understand this important aspect and take admission only if they are fully satisfied. 3. Any change in government rules, regulations, policies pertaining to the courses of competitive exam such as JEE (Main) / JEE (Advanced), Olympiads, KVPY, NTSE etc. which may render these exams as deleted or cancelled. In such eventuality, FIITJEE shall not be held responsible in any manner whatsoever. However, FIITJEE shall take all necessary steps to protect the interest of students.

Students Signature Name : _________________________________ Date : __________________________________ Place : __________________________________

Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________

Enrolment Form

DECLARATIONS / UNDERTAKINGS
Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you

Please read the Declarations / Undertakings carefully before signing Declaration:


1. 2. 3. I/We hereby declare that the information furnished on this enrolment form etc. is correct to the best of my knowledge and belief. I am taking admission in FIITJEE with the consent of my Father / Mother / Legal Guardian and after being satisfied in all respects. 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, at any stage of my association with FIITJEE, 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. 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. However if I fail to do so, FIITJEE may not allow me to attend the classes, unless otherwise allowed by FIITJEE in writing. I/We further undertake that I/We shall not claim any refund of fees/ cost of study material etc. already paid on ground of inability to furnish/complete documents / formalities. I/We understand and acknowledge that FIITJEE does not give any guarantee / promise / assurance for success in JEE (Main) / JEE (Advanced) / XII boards, inspite of providing the best teaching faculty and methodology, 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 succeed the JEE or other competitive exam. I/We understand and acknowledge that preparation for JEE requires exhaustive hard work, extensive study, motivation and self confidence. I undertake that I shall follow the rules and teaching methodology beside study and practice rigorously without loosing self-confidence. I/We clearly understand that FIITJEE on completion of topics to be covered by FIITJEE in Class XI as per its plan, will do goal refocusing for all Two Year Classroom Program students including PINNACLE program students to help each student achieve maximum possible success. This means that some students based on their performance, may have to predominantly focus on exams other than JEE (Main & Advanced). I undertake that if I leave the institute midway before completing the full course for any reason whatsoever, 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., or my studentship is cancelled because of misconduct etc., I or my Father / Mother / Legal Guardian shall not be entitled for refund of fees. I/We undertake that once I (student) join the study centre / program offered by FIITJEE, I/We shall not be entitled to change the study centre / program nor will I be entitled to refund of fees. However, if FIITJEE finds me competent / eligible for the higher course / program, it may consider my request for change of program subject to payment of difference of course / program fee.

4.

5.

6. 7.

8.

9.

10. In addition to the above, I understand without any ambiguity that the fee once paid is not refundable at all, whatever the reasons be, 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. 11. I undertake that I shall abide by the rules & regulations of FIITJEE or FIITJEEs associated schools. I undertake that in case of any dispute relating to breach / violation of any of the Rules & Regulations of FIITJEE or FIITJEEs associated school, the decision of the Management of FIITJEE shall be final and binding in all circumstances and situations, whatsoever. 12. 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. 13. 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 further undertake that I shall not make copies of the study material provided by FIITJEE nor shall provide / give / distribute it to anyone else. 14. FIITJEE has enjoyed great relationship with the students and parents. 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. 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 parents have continued to support the good work of FIITJEE. What will constitute deficiency in service? If the average feedback of the particular subject teacher goes below 70% in the Feedback Form Annexure - FB (attached herewith), then the said teacher will be considered to teach below the minimum FIITJEE Standard. If a teacher gets less than 70% feedback in two consecutive periods then his/her teaching will be considered unsatisfactory by high FIITJEE standards.

15. 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 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. 16. 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.

Students Signature Name : _________________________________ Date : __________________________________ Place : __________________________________

Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________

10

Enrolment Form

DECLARATIONS / UNDERTAKINGS
17. 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/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. I/We further undertake that I/We shall attend the seminars / workshops / felicitation / interview etc. conducted by FIITJEE after achieving rank by the student; however FIITJEE shall alone bear the entire cost and expenses in respect thereof. 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). If we fail to give the JEE admit card by 25th March of the concerned JEE year, 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 to the same. 18. 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, a Video Interview or any other forum / format that FIITJEE deems fit. 19. I/We undertake and acknowledge that incase I/We indulge in any kind of litigation with FIITJEE, I/We shall not be entitled for any Awards / Rewards / Scholarships / Benefits etc. from FIITJEE and shall refund / return such Awards / Rewards / Scholarships / Benefits etc. If availed by the student, within a period of 15 days, failing which FIITJEE shall be entitled to recover the same through the appropriate court / forum alongwith interest, damages and cost of litigation. 20. I/We undertake that I (student) shall not indulge in any illegal / unethical / unprincipled / immoral / corrupt / dishonest activities which may cause loss of property, reputation and goodwill of FIITJEE. I/We further undertake that I/We shall compensate for/ indemnify against any loss /damage caused to FIITJEE. 21. 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. 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. 10 Lacs, if the investigating committee concludes that student had not secured the scholarship on his / her own merits. Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.

22. I/We, the parent / guardian and/or the student, hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form, Annexure and Declarations and agree to abide by them without any reservation or ambiguity. 23. I/We further declare that the student named on page no. 3 is taking admission in the program as mentioned on page 3 having considered everything material, on his/her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission of the Father / Mother / Legal Guardian without any coercion from any side. 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. 24. I/We further undertake to ensure that cheques / drafts including post dated cheques if any given by us will be honoured by our bankers. In the event of these cheques/drafts being dishonoured, FIITJEE is at liberty to initiate any action against us including legal proceedings under section 138 of Negotiable Instruments Act or other appropriate law. 25. I know that registered office of FIITJEE Ltd. is situated at New Delhi. 26. I promise to abide by all rules and regulations of FIITJEE declaration, in letter and spirit. 27. In the event of any dispute between the parties regarding the interpretation of clauses of enrolment form or any claim etc. arising out of taking admission in FIITJEE, the matter shall be referred to the Sole Arbitrator appointed by FIITJEE Ltd. The arbitration proceedings shall be conducted in accordance with the provisions of the Arbitration & Conciliation Act, 1996 and statutory modification thereof & rules made thereunder. 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. Even if the Arbitrator may have expressed opinion in similar matter earlier shall also not render him disqualified. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or Group / Subsidiary Companies, and for reasons of having any prior linkage with the company. The decision of the arbitrator shall be final & binding on both parties. The venue of Arbitration shall be Delhi / New Delhi only. 28. Subject to clause 27 above, I/We (the student and the Father / Mother / Legal Guardian) understand that in case of any legal dispute, 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. In case I do, I shall inform the relevant court / forum regarding this jurisdiction constraint. 29. I have read the above carefully and have understood it clearly. I/We have also read the current FIITJEE Brochure carefully and have understood it clearly. I have kept a photocopy of all the pages of this enrolment form including this declaration and Annexures A, B, C & D for my future reference and timely compliance.

Additional declaration for Integrated School Program Students only :


30. I / We (Student and the parent) am/are joining FIITJEEs Integrated School Program only after satisfying myself / ourselves about the structure of program. Ill fully abide by the rules and regulations of the school. I also understand that in the event I am expelled from the school on any disciplinary ground Ill raise no claim from FIITJEE for any academic and/or financial loss including course fee..

Students Signature Name : _________________________________ Date : __________________________________ Place : __________________________________

Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________

11

Enrolment Form

DECLARATIONS / UNDERTAKINGS
(Declaration to be given by the student if Father / Mother / Legal Guardian does not reside in the Study Centre City, 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. I own all responsibility on their / his / her behalf.

Date : _________________________________ Place : _________________________________

Students Signature : ________________________________ Name : _______________________________________________


(To be struck off, 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, which I shall send to my Father / Mother / Legal Guardian and submit to FIITJEE within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities in writing, 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.

Date : _________________________________ Place : _________________________________

Students Signature : ________________________________ Name : _______________________________________________


(To be struck off, if Not Applicable)

For Office use only Check list for the Accountant / Admission Coordinator.
v v v

Name of the Accountant / Admission Coordinator : _____________________________________________________________ The Application form is complete in all respect with Annexure A, B, C and D duly signed by the student and the parent. The details of the scholarship offered. 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. 6 passport size and one stamp size photograph are attached. Late payment charges / Admin. charges duly calculated and collected. The fee charged has been duly matched and verified with the fee brochure. Signatures on PDCs and on Annexure B and C are same. Is the student joining as a Hosteler? If yes details of the Local Guardian are provided. The student has been offered the admission after selection in Admission test only.


v v v v v v v

Declaration by the Accoutant / Admission Coordinator. I have verified the entire Enrolment form and checked all the points mentioned above. The Enrolment is recommended.

Date : _______________________

Place : _________________________
12

Signature of the Account / Admission Coordinator

Enrolment Form

Classroom / Integrated School Programs


Program Name For Admission in Class 6th
Little Genie - One Year Foundation Program - Regular Week Contact Classes Little Genie - One Year Foundation Program - 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 - Two Year Integrated School Program UDAYA - Two Year Classroom Program - Regular Week Contact Classes UDAYA - Two Year Classroom Program - Weekend Contact Classes UDAYA - Two Year Classroom Program - 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 - One Year Classroom Program - Regular Week Contact Classes UDAYA - One Year Classroom Program - Weekend Contact Classes UDAYA - One 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 - Four Year Integrated School Program for JEE (Advanced) ATHENA - Four Year Integrated School Program for JEE (Main) Four Year Classroom Program for JEE (Advanced) - Regular Week Contact Classes Four Year Classroom Program for JEE (Advanced) - Weekend Contact Classes Four Year Classroom Program for JEE (Advanced) - Sunday Contact Classes Four Year Classroom Program for JEE (Main) - Regular Week Contact Classes Four Year Classroom Program for JEE (Main) - Weekend Contact Classes Four Year Classroom Program for JEE (Main) - Sunday Contact Classes LIBERTY - Four Year Integrated School Program for Admission to Worlds Top Universities Four Year Classroom Program for Admission to Worlds 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 - Regular Week Contact Classes Three Year Classroom Program for IIT-JEE - Weekend Contact Classes Three Year Classroom Program for IIT-JEE - Sunday Contact Classes Three Year Classroom Program for Admission to Worlds Top Universities 1061 1062 1063 1042

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Enrolment Form

Classroom / Integrated School Programs


Program Name For Admission in Class 11th
Pinnacle - Two Year Integrated School Program for IIT-JEE Two Year Classroom Program for JEE (Advanced) - Regular Week Contact Classes Two Year Classroom Program for JEE (Advanced) - Weekend Contact Classes Two Year Classroom Program for JEE (Advanced) - Sunday Contact Classes Two Year Classroom Program for JEE (Advanced) - Special Weekend Contact Classes Two Year Classroom Program for JEE (Advanced) - Regular Week + Sunday Contact Classes Two Year Classroom Program for JEE (Main) - Regular Week Contact Classes Two Year Classroom Program for JEE (Main) - Weekend Contact Classes Two Year Classroom Program for JEE (Main) - Sunday Contact Classes Two Year Classroom Program for JEE (Main) - 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 - Sunday Contact Classes GOLDEN BRIDGE - Two Year Integrated School Program for Admission to Worlds Top Universities Two Year Classroom Program for Admission to Worlds 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) - Regular Week Contact Classes One Year Classroom Program for JEE (Advanced) - Weekend Contact Classes One Year Classroom Program for JEE (Advanced) - Sunday Contact Classes One Year Classroom Program for JEE (Advanced) - Regular Week + Sunday Contact Classes One Year Classroom Program for JEE (Main) - Regular Week Contact Classes One 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 + Sunday Contact Classes USA UnivQuest - 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) - Regular Week Contact Classes One Year Classroom Program for JEE (Main) - 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

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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)

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.L.N. 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

National Admissions Office : FIITJEE House, 29-A, Kalu Sarai, Sarvapriya Vihar, New Delhi - 110 016 Ph. : 011 - 46106000 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax : 011 - 26513942 Web : www.fiitjee.com

Enrolment Form w.e.f. 11th November, 2012