MBA, 2010

For Office Use only

12, Masilamani Street, T. Nagar, Chennai – 600 017. Student No: B A P 1 0

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ENROLMENT FORM
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POSTAL SUPPORT PROGRAMME
FOR ADMISSION TO MANAGEMENT DEGREE (MBA) COURSES IN 2010 4.5 × 4.5 cms
INCLUDING CAT, 2009 Enclose two
PLEASE ENSURE THAT THIS IS THE COURSE additional photographs
YOU WISH TO APPLY AND ENROL FOR. with this Form
The Principal, COMPLETE AND SIGN BOTH SIDES OF THIS (Enrolment forms
BRILLIANT TUTORIALS PVT. LTD. FORM.
will not be accepted
without three
Sir, photographs)
I have graduated/will graduate in ………………… in the year ………… from
.......................................................................................(Name of the Institution) (Place)
I am employed as …………………………………… in ……………………..…………… (Name of Employer)
Have you previously enrolled in any of our courses
Yes No
If Yes, Course……………………………………………….
Enrolment No.
REFERENCE NUMBER: B T ………...……………..
Please enrol me as a student of
Your Postal Course for the 2009-2010 MBA Entrance Exams with the Online Test Series Fee: Rs.7700 + Service Tax Rs.793/-
Total: Rs.8493/-
Your Online Test Series for MBA Entrance, 2009-2010 Fee: Rs.1999/- + Service Tax Rs.206/- Total: Rs.2205/-
I herewith remit the full course fee of: Rs.8493/- Rs.2205/-
MO/DD drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai.

MO Receipt / DD No. Bank Date

Online Bank Transfer/ Credit Card Visa Master Card
(Bank routing instructions given below) Transaction Confirmation No. Date
Cash/ Credit/Debit Card at your Centre in Credit/Debit Card Authorization Code

(See overleaf for list of Centres) Last 4 Digits of Card No.

(Please 3 the appropriate boxes)
I have read and shall abide by the rules and regulations for this Course given in the Online / Hardcopy Prospectus.
Fees once paid will not be refunded or adjusted under any circumstances.
BANK ROUTING DETAILS
All matters are subject to the exclusive jurisdiction of courts in
Chennai only. Pay to: Brilliant Tutorials Pvt Ltd.
Yours faithfully, Account No. 014010200034654
Account Branch AXIS BANK LTD, T.NAGAR, CHENNAI – 600 017.
IFSC Code For RTGS: UTIB0000014
Signature of Applicant IFSC Code For NEFT: UTIB0000248
Date: Note: Bank charges to be paid by student
(PLEASE PRINT IN BLOCK LETTERS)
Applicant’s Name (as in school records) …………………..:
Date of Birth …………………………………………………..…: Sex: Male Female
Permanent Home Address:

Telephone: STD Code: Number:

Own PP

Fax: E-Mail: * PIN CODE:

Name and Full Postal Address to which all
Correspondence and study material
should be despatched:

Telephone: STD Code: Number:

Own PP
Fax: E-Mail: * PIN CODE:
Our course material is in the English Medium only • Fees once paid will not be refunded or adjusted under any circumstances. •
No instalment facility. • Enrolment will not be accepted without the photograph/s. • PIN CODE, AN ABSOLUTE MUST. •
Your Enrolment form for admission will not be accepted unless your address is complete with Pin Code. *E-mail mandatory
REMEMBER TO SEND TWO ADDITIONAL SIGNED PHOTOGRAPHS WITH THIS FORM.
Please keep a copy of this form for your records
 BRILLIANT TUTORIALS
url: www.brilliant-tutorials.com
PVT.LTD.
email: enquiries@brilliant-tutorials.com

COURSES OFFERED
• Classroom and/or Correspondence Courses for
IIT-JEE - For Stds. IX, X, XI and XII
All-India Engineering Entrance Exam (AIEEE) and BITSAT - For Stds. XI and XII
Medical Entrance Exams - For Stds. IX, X, XI and XII

• YG ("YOUNG GENIUS") File with B.MAT (Brilliant's Mock All-India Tests)

One-year Test Series for IIT-JEE - For Std. XII
• Med.QB (Medical Question Bank) with B.NET (Brilliant's National Evaluation Tests)
One-year Test Series for Medical Entrance Examinations - For Std. XII
• Graduate Aptitude Test in Engineering (GATE) • MBA Entrance Examinations
• Civil Services Examination • Engineering Services Examination
• Joint CSIR-UGC (NET) • BPOE
• GRE, TOEFL

CENTRES

CHENNAI - (Registered Office)

No.12, Masilamani Street, T.Nagar, Chennai 600 017. Tel: +91-44-2434 2099; Fax: +91-44-2434 3829

NEW DELHI
50-C, Kalu Sarai (Behind Azad Apartments), New Delhi 110 049. Tel: +91-22-2653 7392, 93, 94, 95. Fax: +91-22-2653 7396
(Five locations – please call for address of Center closest to you)

EAST DELHI
13-A, Pratap Nagar, Mayur Vihar Phase-I, New Delhi 110 091. Tel: 2279 2226, 27, 28, 29.
NORTH DELHI
19-20, Central Market, Punjabi Bagh (West), New Delhi 110 026. Tel: 2522 1424, 25.
WEST DELHI
A-1/295, Janakpuri (Pankha Road), New Delhi 110 058. Tel: 2552 7515, 16, 17, 18
BANGALORE
No.5, II Floor, Kasthuri Apartments, Near Double Road Junction, Behind MRF Showroom, 35/22, Langford Road,
Bangalore 560 027. Tel: +91-80-4144 2127, 2128

COIMBATORE
No.5/2, Nehru Street, Opp: Kavitha Theatre, Ramnagar, Coimbatore 641 009. Tel: +91-422-4377 457, 458

DWARKA
Raj Laxmi Plaza, Plot No. 15, Sector 5, Dwarka, New Delhi 110 075. Tel: 2508 6117, 18

GURGAON
M-1, Old DLF Colony, Sector 14, Gurgaon 122 001. Tel: +91-124-426 8015, 426 8016
KOCHI
39/4210, Ground Floor, M.G.Road, Near Sarada Math, Ravipuram, Kochi 682 018. Tel: +91-484-4028 770, 771
KOTTAYAM
II Floor, Kalarickal Building, South Manorama, Kottayam 686 001. Tel: +91-481-2585 152
MADURAI
72/193, Meenas Building, Bye-Pass Road, Madurai 625 016. Tel: +91-452-4351 075
MYSORE
MIG-7, 1st Floor, 1st Stage, Udaya Ravi Road, Mysore 570 023. Tel: +91-821-4262 128/4264 127

SALEM
454/4, Ram Complex, II Floor, Near Bus Stand, ARRS Multiplex Road, Salem 636 009. Tel: +91-427-4265 779
TRIVANDRUM
C-1, Future Plaza, Dhanya – Remya Theatre Road, Kunnumpuram, Trivandrum- 695 001. Tel: (0471) 4010 999
TRICHY
D-110, 9th Cross, East Thillai Nagar, Trichy – 620 018. Tel: (0431) 4023 353, 363