Fathers Name:. ......................................................................

Fathers Designation:...............................................................
Fathers Contact No.:...............................................................
Correspondence Address: ......................................................
.................................................................................................
Students e-mail: ....................................................................
Phone (with STD Code): ........................................
Pin
Wrong Method Wrong Method Wrong Method Wrong Method Correct Method
Corporate Office: 44-A/1, Kalu Sarai (Sarvapriya Vihar) New Delhi-110016 |
Ph: 011-45124612, 9958995830, 9810541651
E-mail: madeeasydelhi@gmail.com
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DATE OF BIRTH QUALIFYING DEGREE
Branch
%
Passing Year
STUDENT / CANDIDATES NAME (IN BLOCK LETTER ONLY)
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SIDE 1
IMPORTANT INSTRUCTION: USE ONLY BLACK BALL POINT PEN TO FILL UP THE FORM
ROLL NUMBER (To be assigned by office)
APPLICATION NUMBER (To be assigned by office)
TEST SERIES ENROLLMENT FORM-2013
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ME
EE
EC
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CATEGORIES
General
OBC
SC
ST
FATHERS OCCUPATION
Govt. Employee Class 4
Govt. Employee Class 1
Private Job
Doctor
Business
Farming
Teaching
Govt. Employee Class 3
Govt. Employee Class 2
Others
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EXAM CODE
GATE Test Series
Others
IES Test Series
PSU Test Series
TEST CENTRE
Delhi
Noida
Bhopal
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MOBILE NUMBER
CORRESPONDENCE ADDRESS (IN CAPITAL LETTERS)
Signature of candidate
Paste Photo
of Candidate
Do not staple
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MADE EASY Office: Delhi Hyderabad Noida Bhopal
Lucknow
Jaipur 4
5
Jaipur Lucknow
PERMANENT ADDRESS (IN CAPITAL LETTERS)
EDUCATIONAL DETAILS (IN CAPITAL LETTERS)
UNDERTAKING
.......................................................................................................................................................................................
.......................................................................................................................................................................................
Phone (STD Code): ........................................................................................................... Pin: ..................................
Branch of Engg.
B. Tech
Name of College & City % Marks
I, _______________________________________ am applying for admission in __________________ program of the institute.
I certify that the information given by me is true to the best of my knowledge and belief. I understand that if anything is found
false/incorrect at any state, my candidature/admission to the course shall be cancelled without any refunds.
I shall abide by all the rules and regulations of MADE EASY. Also, I will have no objection on publication of my photo by the
institute after my selection in the competitive exam and the institute (MADE EASY) will be entitled to use my photo and details for its
advertisement purpose.
I have enclosed the self-attested copy of ID/Proof/Address Proof .
Date:
Place: Signature of the Candidate
M. Tech
Passing Year
PROOF OF IDENTITY (Submit self attested copy of ID proof)
(*In case of absence of proof of candidate, fathers identity/address proof can be submitted)
Passport Election I-Card Driving License College I-Card PAN Card Others (Specify)
Name of card holder: Card No.
Checked by (for office use): Signature (for office use):
I ________________________ guardian* ____________ (relationship with the student) of _______________________________
(Student Name) hereby declare that I have completed all the formalities on behalf of the candidate. Also I have read and understood
all the terms and conditions of MADE EASY.
Signature
SIDE 2
* If candidate is not present, then guardian can sign.
DD No.
DEMAND DRAFT
DETAILS
Amount Bank Name City