Enrollment No……………….
(To be filled by office)



The Aakash Classes
A Leading lcon of Education for IIT, PMT, Foundation
(Particulars to be filled by Students)
ENROLLMENT FORM

 

Affix your recent passport size photograph here.

To,
Managing Director
The Aakash Classes
Patna

Respected, Sir,       Centre Name: ________________________________

I want to enroll for Regular Course/ Crash Course of your Institute; I have read the Terms and Conditions of the Institute given overleaf and agree to abide by the same. My particulars are given below for your consideration & correspondence.

THE FORM IS TO BE FILLED IN CAPITAL LETTER ONLY

 
Name of the Students :
Father's/ Guardians Name :
Occupation of Father :
Residencial Address :
Phone Nos.: Residence with STD code Office No.:
Gender:
Date of Birth: DD: MM: YYYY: Blood Group :
Address for Correspondance:

Phone Nos with STD Code : E-Mail ID :

Have you joined any other institute for preparation of Medical Entrance Exams, if yes, then write the name of the institute:
Name of the School from where you appeared/appearing for class X - XII:
Date: (dd/mm/yyyy) Place :
 

 

Signature : _____________________________________

I hereby certify that the information submitted by me is true to the best of my knowledge.