GATE 2014 OFFLINE ENROLLMENT FORM

Enrollment for the year

For Official use

Receipt no.: Date Recd. :

: 2014

City :

PLEASE FILL UP ALL PARTS OF THE FORM VERY CAREFULLY IN BLOCK LETTERS
First Name Name Email ID Middle Name Last Name

: :

Photograph

Alternate Email ID : Landline No. Date of Birth

: :
D D M M Y Y Y Y

Postal Address : ______________________________

Flat No : ______________________________ Name of premises : ______________________________

Please paste your recent passport photograph here

Alternate Mobile No. Fathers Name

Road/Street : ______________________________

I agree with terms and conditions on the reverse

______________________________ City:
____________

Fathers Contact No.

PIN: Signature of Candidate

ACADEMIC BACKGROUND
Highest Qualification (Tick the correct option): Currently: Working at BE/B.Tech

Aggregate college percentage: ME/M.Tech MCA Studying M.Sc. Other (Specify)

____________

Graduated but not working

Full Name of Graduating College City of Graduating College Year of passing out of graduation

Previous Attempt at GATE: Year Rank Newspaper Ads________________________ College Posters Friends / Colleagues Classroom CH BT
DLP Plus

Stream Not Applicable Leaflets Seminars Banners

Score

GATEFORUM Reached You Through:

SMS

Online Ads

Google Search Postal

Others__________________________

ENROLLMENT DETAILS
Stream: EC CS ICP Plus ME

Mode of Test Series:

EE IN CE

FOR OFFICE USE

Classroom Coaching Venue

GATE PACKAGES :

Intensive Classroom Program (ICP) Online TarGATE (OTG) Online Test Series

Batch ID Test Series Venue Roll number generated online:

Distance Learning Program (DLP) All India Test Series (TarGATE) eGATE Others

(Other Package Name)

UPGRADES/INSTALLMENTS
Upgraded to:

PAYMENT MODE
Cash Cheque DD Card Online Transfer Others
____________

AMOUNT PAID
**

Rs.
On:

Instrument of Bank and Branch: ____________

Upgrade/Installment Receipt No.

____________
**

Instrument Number: ___________ Instrument Date:

____________

**

Books Issued

LOGISTICS On D D

Courier Name & No. COMMENTS

____________ ____________

Logistics Comments

CHECK LIST
To Enroll Please Send/Submit the Following : 1. Completely Filled up Application Form 2. Two photographs attached to the Enrollment Form, as specified. 3. DD/Cheque # (should be) in favour of Gateforum Educational Services (P) Ltd, payable at Hyderabad. For online transfer please refer website or download updated enrollment form from www.gateforum.com. Send Transaction Record Printout in case of Online Transfer. Send Original Receipt in case of Cash Deposit at any ICICI Bank branch in India. Account Details: A/c. No: 018305006169 IFSC Code: ICIC0000183 ICICI Bank Ltd., Begumpet Branch, Hyderabad. ** Instrument may be Cheque/ DD/ Credit Card, Account Number, etc.,

Photograph
Please Staple one Passport-size photograph here. Write the Name and City on the reverse side of your photo.

INCOMPLETELY FILLED UP FORMS WILL BE SUMMARILY REJECTED.

Terms and Conditions

For any enquiries Call 040 - 44664243 or send mail to enquiry@gateforum.in
1. GATE Packages (2014)
eGATE - Live Classes - Fees - Rs. 16,000. ICP - Intensve Classroom program - Classroom Coaching + Correspondence Course (CC) + TG / OTG. ICP Plus - Classroom Coaching + eTutor + Correspondence Course (CC) + TG / OTG. DLP - Distance Learning Program - Correspondence Course (CC) + Online TarGATE (OTG). Fees - Rs.9,000. DLP Plus - Correspondence Course (CC) + eTutor + Online TarGATE (OTG). Fees - Rs.11,000. TarGATE (TG) / Online TarGATE (OTG). Fees - Rs. 3,500. Online Test Series - Online Test (OT). Fees - Rs. 1500.

2. Fees once paid will not be refunded under any circumstance. After paying the fees, even if a student is eligible for any discount, the amount paid will not be refunded. 3. GESPL reserves the right to announce and withdraw discount schemes at its own discretion and no claim of any kind will be entertained in this matter. 4. In case a student goes for upgrade/change of packages/change of center/change of city, etc. an extra amount may be charged as per company policy apart from normal fees for the packages. 5. GESPL reserves the right to change the schedule and timings of classes and tests at its own discretion. 6. While utmost care is taken to provide correct and up to date information, GESPL does not guarantee the accuracy, completeness and timely availability of the information provided and accepts no responsibility or liability for any error or omission in any information provided. 7. In case of reprint of study material during the academic year, due to lack of stocks or a revision of content, GESPL does not take the responsibility to distribute the reprinted edition to the students who were admitted earlier. 8. GESPL reserves the right to change the date of issue of study material and will not be liable for any delays in the material or test papers reaching a student. 9. GESPL reserves the right to cancel a center and transfer the center students to another center in the same city, in case of ICP. GESPL also reserves the right to convert the mode of a student from Classroom to Postal under extraordinary circumstances of having to close down a center. 10. The study material, CD, test material etc. are exclusive copyright of GESPL, and cannot be reproduced in print or otherwise, without explicit permission of GESPL. 11. The student has gone through the terms and conditions. By enrolling, a student agrees to abide by the rules and regulations and company policies of GESPL as specified on this page, and on the website at: Detailed terms and conditions can be found at our website : http://www.gateforum.com/termsconditions.php For all purposes, Gateforum Educational Services Private Limited is referred to as GESPL above. I understand the terms and conditions and I agree to abide by the terms and conditions of Gateforum. Name : _______________________________________

Student Signature