PS-ID / Registration No. ...................................................

Date: D D M M Y Y Y Y
Receipt No. ..........................................................................
(To be filled by office only)

To, Affix your

The Manager - DLP Division recent passport
Aakash Institute size colour
Aakash Tower, 8, Pusa Road, photograph
New Delhi-110005 here.

ADMISSION FORM FOR DLP MEDICAL COURSES 2019-21

COURSE APPLIED FOR: (Please mark (✓

) against the course you wish to apply)

2 Yr. Course for NEET/AIIMS-2021: CSP CJP+ 1 Yr. Course for NEET / AIIMS - 2020: CSP CJP+ XII Studying XII Passed
If Offline AIATS, Please write Centre Name & Code:
2 Yr. AIATS for NEET/AIIMS-2021: 1 Yr. AIATS for NEET/AIIMS-2020: XII studying XII passed Mode of AIATS Online: English or Offline: English Hindi

Aakash Explorer for AIIMS: 2021 2020 1 Yr. Last Leap for NEET 2020: 1 Yr. Target NEET-2020: 1 Yr. Target AIIMS-2020: XII studying XII passed

Online Test Series for IAPT-NSEP/C/B/A: Online Test Series for KVPY (SA & SX): Medium of CSP: English Hindi

NTSE (Stage-II) Test Series: Online Online+Books Offline+Books Roll No. of NTSE (Stage-I) Qualified Students

CSP - Comprehensive Study Package, CJP+ - Comprehensive Joint Package Plus, AIATS - All India Aakash Test Series, NTSE - National Talent Search Examination,
KVPY - Kishore Vaigyanik Protsahan Yojana, NSEP/C/B/A - National Standard Examination in Physics / Chemistry / Biology / Astronomy
Respected Sir,
I want to take admission in your esteemed Institute for the Distance Learning Program Course in Medical Stream marked (✓
) in the box. I have read the 'Terms &
Conditions' of the institute given overleaf and agree to abide by the same. My particulars are given below:

(It is compulsory to fill the form clearly in CAPITAL LETTERS only) Mandatory fields are marked with asterisk (*)
Personal Details
First Name*:
Last Name*:
Father’s/Guardian’s Name:
Mother’s Name:
Occupation of Father / Guardian:
Occupation of Mother:
Gender (M/F): Blood Group: Category* (GEN / OBC / SC / ST / PH):
Date of Birth*: D D M M Y Y Y Y
Nationality:
Aadhar No.

Correspondence Address
Address:

City:
State: PIN:
Phone (Residence): S T D Phone (Office): S T D
Mobile Parents#: Student: SMS:

E-Mail ID*:
Facebook ID:
Twitter@:

Education Details
Student Class Category: X passed / XI studying XII studying XII passed (Please ( ✓
) in the relevant box)

School / College Name & Address:

Marks Obtained: % (X Board, Sc. & Maths - Aggregate) and / or % (XII Board, PCB - Aggregate)

Grades Obtained: (CBSE Class X) Exam. Board: (CBSE | ICSE/ISC | HS | Other)

(In Science) (In Maths) (Attach a Self-attested Photocopy of Your Original Marksheet)

If Ex-Aakashian, please mention your Aakash Roll No.: Section:

Eligibility for Scholarship: 5% 10% 15% 25% 35% Others:

How did you come to know about Aakash? Promotions Team Newspaper Teachers Friends/Relatives Ex-Aakashians Website Radio/TV

Sincerely,
Date: D D M M Y Y Y Y
Place:
#
Kindly give such number which is not in National Customer Preference Registry (NCPR) mode.
(Signature of the Student)*
For Office Use Only (Please tick (✓
) the relevant box)

Category of Scholarship Category-A Category-B

Demand Draft No.: Amount ( ): Drawn on: Date:

PS-ID / Registration No.: Office Receipt No.: Receipt Date: Prov. Receipt No.:

Admission Place: Centre Promotions Executive Counsellor (Name):

Terms & Conditions

1. Incomplete Forms shall not be considered under any circumstances. 15. For the change of AIATS Mode and Centre, ` 500/- (for each change) will also be

2 If there is any pendency in admission form, after 1st dispatch further dispatch will
be on hold.
3. The duly filled in Admission Form should be sent to the Corporate Office or nearest
centre.
4. It is compulsory to attach self-attested photocopy of mark-sheet of the last
qualifying Exam (X or XII).
5. It is compulsory for students to paste a recent passport size colour photograph in
the space provided and also staple two extra colour photographs with the
Admission Form.
6.
Institute reserves the right to use the single/group photograph(s) for publicity in all
kinds of media in case the student(s) secures position/rank or succeeds in Medical
Entrance Exams.
7.
Students enrolled in Aakash Institute’s DLP Medical Course will have to provide
photocopy of Admit Card of Medical (NEET/AIIMS/JIPMER) Entrance Exams as
soon as they receive their admit cards from the exam conducting body.
8.
Refund & Transfer Policy will be applicable as per prospectus.
9.
It is for the student to see whether he / she is eligible for a certain Medical
Entrance Examination or not. The Institute does not hold itself responsible if a
student's admission form cannot be forwarded or is rejected by the examination
body on any ground whatsoever. Such a student cannot claim a refund of the whole
or any part of the fee he/she has paid to the Institute.
10. The responsibility of getting admission form forwarded to the exam conducting
body is that of the student himself/herself or that of the Parents / Guardian.
11.
In case of school Tie-up, School Principal / Signing Authority / Parents will be
treated as Guardian.
charged from DLP enrolled students. Mode and Centre can be changed once in a
session.
16. If at any point of time, the Central Govt. further increases GST, (existing rate of GST
is 18%) the extra amount of GST will be borne by the students from the date of
enforcement of the act by the Govt.
17. Aakash Institute reserves the right to make any alteration in its programs / venue /
timing without any prior notice. The decision of the Director will be final and
binding on the students as well as the parents.
18. The Examination Centre of any place can be changed as per the requirement/need
of the company without any prior notice to the students / parents.
19. If any student fails to receive the study material within 15 days from the date of
dispatch, kindly inform the DLP Division telephonically at 011-47623445 /63 or
by writing an E-mail at: dlp@aesl.in
20. Do not Disturb (DND): AESL may also contact the user through SMS, WhatsApp,
email and call to give notifications on various important updates. Therefore, User
holds AESL non liable for any liabilities including financial penalties, damages,
expenses in case the users mobile number is registered with Do not Disturb (DND)
database.
21. In case of any dispute or difference between you and Institute regarding the
interpretation of these terms and conditions, non-payment of any claim or any
dispute arising out of or in pursuant to these terms and conditions, the same shall
be referred to sole Arbitrator who shall be appointed by Managing Director of M/s
Aakash Educational Services Limited. The proceedings shall be conducted at New
Delhi under the provisions of Arbitration & Conciliation Act and the Courts at Delhi
only shall have the jurisdiction over the matter and/or for enforcement as the case
may be. If an Arbitrator to whom the matter is referred refuses to act or for any
reason, does not enter the reference or after entering into the reference

12. proceedings are abandoned or kept in abeyance or not proceeded with, it shall be
If the study material provided to the student is lost / misplaced once delivered at lawful for the Managing Director of M/s Aakash Educational Services Limited to
his/her correspondence address, a duplicate book can be obtained against the appoint another person to act as an Arbitrator in the manner aforesaid. Such
payment of ` 300/- per book (including GST), through DD / Cheque /Online / Card. person shall be entitled to proceed with reference from the stage at which it was
13. If the dispatch is returned to us due to change of address / door locked / non-
left by his predecessor, if both the parties consent to this effect, failing which the
availability of addressee, the courier / postage charges of ` 500/- will be charged Arbitrator will be entitled to proceedde novo .
for sending the dispatch again. If the said amount is not paid by the student then
rest of the dispatches will be held.
14.
Any change in address or phone numbers should be notified to the DLP Division
15 days prior from the next dispatch date without any delay through a written
application or email at dlp@aesl.in otherwise rest of the dispatches will also be
stopped.

I have read the Terms & Conditions of AESL and various policies of the Company as mentioned in the prospectus & promise to abide by the same.

(Signature of the Parents/Guardian*) (Signature of the Student*)

Note: It is mandatory for student & parents to sign at the appropriate places failing which admission form will not be processed and will not be considered.

*Checklist
Three recent passport size colour Photographs (latest).
Photocopy of self-attested mark-sheet of the last qualifying Exam. (X or XII) as applicable.
DD in favour of ‘Aakash Institute’ payable at the nearest Centre .
Centre Code, Centre Name and Medium of AIATS should be properly mentioned on the Admission Form.
If you are an Ex-Aakashian, attach a photocopy of Identity Card issued by Aakash along with the Admission Form.
Attach proof of Scholarship along with the Admission Form to avail concession.
Provide E-Mail ID & Mobile no. for sending of information / SMS.
It is compulsory for Parents / Guardian and student to sign on the Terms & Conditions.