ENROLMENT FORM

Enrolment No. :
(For official use only)

Correspondence Programs

(To be filled by the student)

Name of Program Enrolling for : Preference of Test Centre for AITS for JEE (Main & Advanced) :
(For list of test centres see page 2)

Please Affix Your Recent Passport Size Colour Photograph

Please mention your Enrolment No. in case you are already enrolled in any other FIITJEE program :

Name of the Candidate Father's/Guardian's Name Date of Birth

: : :
D D M M Y Y Y Y

Nationality :

Correspondence Address

Pin Ph. (Res.) with STD Code : Permanent Address : Mobile No* * :

Pin Ph. (Res.) with STD Code : School affiliated to Class : : CBSE VII VIII ICSE IX Mobile No : Others (Please Specify) XI XII XII (pass)

Marks in Sc + Math / PCM (%) Obtained : Marks (if in Grades ) Category of Student E-mail ID of the Student : : :

X Board

% Maths

XII Board XII Board - P

. C

% M

X Board - Science General

Others (Please specify) _________________________

** Please mention if you want to recieve information through SMS on this mobile:
All India Toll Free No. : 1800 11 4242

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FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Fax: 0124 - 428 3133 Website : www.fiitjee.com

Nearest relative / Guardian Address (to be contacted in case the candidate is not available at the above mentioned addresses) :

Pin Ph. (Res.) with STD Code : Name and Address of School : (studying or passed) Mobile No:

Pin Phone. :

TEST CENTRES$ FOR ALL INDIA TEST SERIES (AITS) for JEE (Main & Advanced), 2014 / 2015 (Only one centre can be opted.) : Delhi (South), Delhi (North-West), Delhi (East), Delhi (Dwarka), 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, 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 (Chembur), Mumbai (Sion), Mumbai (Thane), Muzzafarpur, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee*, Rourkela, Shakti Nagar NTPC, Siliguri, Thrissur, Trivandrum, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Visakhapatnam.
Above are the test centres for All India Test Series for JEE (Main & Advanced) only. (For centres of Concept Strengthning & Analysis Program (CSAP), please contact your nearest FIITJEE Centres.) * Roorkee is the test centre only for Open Test.
$

Note : All India Test Series (One Year & Two Year) is also available by Correspondence
(All the Test Papers to be received & attempted at your home.)

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

CHECK LIST 1. Photocopy of X / XII board marksheet* VIII school final exam marksheet* (for Junior Rankers Study Material) 2. Photographs colour (3 passport & 1 stamp size) 3. Demand Draft for course fee * In case of claim for scholarship, marksheet / certificate of Scholastic Achievement is to be attested by the past or present school Principal.
FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 All India Toll Free No. : 1800 11 4242 Fax: 0124 - 428 3133 Website : www.fiitjee.com
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For JEE (Main & Advanced), 2014 I am interested in enrolling for (Tick the appropriate box) Rankers Study Material (One Year Version) One Year All India Test Series One Year All India Test Series
(By Correspondence)

For JEE (Main & Advanced), 2015 I am interested in enrolling for (Tick the appropriate box) Rankers Study Material (Two Year Version) Two Year Integrated All India Test Series Two Year Integrated All India Test Series
(By Correspondence)

For students of class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad & Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams I am interested in enrolling for (Tick the appropriate box) Jr. Rankers Study Material

Note 1 : Note 2 : Note 3 : Note 4 : Note 5:

Fee of any program is not refundable at any stage. 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. Please write your name behind your photograph and your name & address behind the demand draft. The Demand Draft for course fee for all the above mentioned JEE programs should be in favour of "FIITJEE LIMITED - TS, RTPF, GMP A/c" payable at New Delhi. Photocopy of this form can also be used.

Place: __________________ Date: _______________

(Signature of the Student)

(Signature of the Parent / Guardian) Name __________________________________________ Relationship with the student _______________________ Mob. No. of Parent / Guardian ______________________

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 All India Toll Free No. : 1800 11 4242 Fax: 0124 - 428 3133 Website : www.fiitjee.com

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Last date to receive completed applications for following programs for JEE (Main & Advanced), 2014
Rankers Study Material (One Year Version) One Year All India Test Series One Year All India Test Series (By Correspondence) : : : : : 31st August, 2013
Despatches are done fortnightly to all new enrolments.

14th October, 2013 21st October, 2013

Last date to receive completed applications for following programs for JEE (Main & Advanced), 2015
Rankers Study Material (Two Year Version) Two Year Integrated All India Test Series Two Year Integrated All India Test Series
(By Correspondence)

: 20th September, 2013

Despatches are done fortnightly to all new enrolments.

: 18th November, 2013 : 25th November, 2013

Last date to receive completed applications for following program for students aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad & Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams
Jr. Rankers Study Material : 20th September, 2013

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 All India Toll Free No. : 1800 11 4242 Fax: 0124 - 428 3133 Website : www.fiitjee.com

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