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ENROLMENT FORM Correspondence Programs

Enrolment No. :
(For official use only)
Please Affix
(To be filled by the student)
Your Recent
Passport Size
Name of Program Enrolling for : Colour
Photograph
Preference of Test Centre for AITS :
(For list of test centres see page 2)

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 : Nationality :


D D M M Y Y Y Y

Correspondence Address :

Pin

Ph. (Res.) with STD Code : Mobile No :

Permanent Address :

Pin

Ph. (Res.) with STD Code : Mobile No :

School affiliated to : CBSE ICSE Others (Please Specify)

Class : VII VIII IX XI XII XII (pass)

Marks in Sc + Math / PCM (%) Obtained : X Board . % XII Board . %

Category of Student : General Others (Please specify) _________________________

E-mail ID of the Student :

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-4610 6000, 2651 5949, 2656 9493 All India Toll Free No. : 1800 11 4242 Fax: 011-2651 3942 Website:www.fiitjee.com 1/4
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 : Mobile No:

School Address (studying or passed):

Pin

Phone. :

TEST CENTRES* FOR ALL INDIA TEST SERIES (Only one centre can be opted.) (Tick the appropriate box) :
Delhi (South) Delhi (North-West) Delhi (East) Delhi NCR (Gurgaon)
Delhi NCR (NOIDA) Delhi NCR (Faridabad) Delhi NCR (Ghaziabad)
Agra Ajmer Allahabad Amritsar
Aurangabad Bangalore Bareilly Baroda
Bhagalpur Bhatinda 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 (Sion) Mumbai (Thane) Muzzafarpur
Nagpur Patna Pune Ranchi
Rohtak Rourkela Shakti Nagar NTPC Trissor
Trivandrum Udaipur Ujjain Varanasi
Vijayawada Vishakapatnam
* These are the test centres for IIT-JEE Test Series only. For test centres of AIEEE Test Series, please contact FIITJEE Centres.
Correspondence (All the Test Papers to be received & attempted at your home.)

Test Centres for OPEN TEST Only : Ahmedabad Roorkee


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

CHECK 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 is to be attested by the past or present school Principal.
FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-4610 6000, 2651 5949, 2656 9493 All India Toll Free No. : 1800 11 4242 Fax: 011-2651 3942 Website:www.fiitjee.com 2/4
For IIT-JEE, 2011
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 IIT-JEE, 2012


I am interested in enrolling for (Tick the appropriate box)

Rankers Study Material (Two Year Version) All India Test Series (for Class XI only)
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, Olympiads & SAT


ASCENT in The Box

For students of class VII & VIII aspiring to excel in NTSE

TARGET NTSE in The Box for NTSE 2011 - 2012 (for Class VII)

TARGET NTSE in The Box for NTSE 2010 - 2011 (for Class VIII)

Place: _____________________ Date: ____________________ (Signature of the Student)


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, GMP
A/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.

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-4610 6000, 2651 5949, 2656 9493 All India Toll Free No. : 1800 11 4242 Fax: 011-2651 3942 Website:www.fiitjee.com 3/4
Last date to receive completed applications for following programs for IIT-JEE, 2011

Rankers Study Material (One Year Version) : 31th August, 2010


: Despatches are done fortnightly to all new enrolments.

One Year All India Test Series : 10th October, 2010


:
One Year All India Test Series (By Correspondence) : 17th October, 2010

Last date to receive completed applications for following programs for IIT-JEE, 2012

Rankers Study Material (Two Year Version) : 20th September, 2010


Mailing commences from April, 2010
Two Year Integrated All India Test Series : 31st October, 2010

Two Year Integrated All India Test Series : 7th November, 2010
(By Correspondence)

All India Test Series (for Class XI only) : 31st October, 2010

Last date to receive completed applications for following program for students
aspiring to excel in IX, X, Olympiads & SAT

ASCENT in The Box (Two Year Correspondence Course) : 20th September, 2010

Last date to receive completed applications for following program for students aspiring to excel in NTSE

TARGET NTSE in The Box for NTSE 2010 - 11 : Enrolment is ON

TARGET NTSE in The Box for NTSE 2011 - 12 : Enrolment is ON


240210

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016
Ph: 011-4610 6000, 2651 5949, 2656 9493 All India Toll Free No. : 1800 11 4242 Fax: 011-2651 3942 Website:www.fiitjee.com 4/4