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Form Fiitjee
Form Fiitjee
Enrolment No. :
(For official use only)
Correspondence Programs
FIITJEE
Preference of Test Centre for AITS for JEE (Main & Advanced) :
(for list of Test Centres see page no. 3)
Name of the Student Fathers/Guardians Name Mothers Name Date of Birth Correspondence Address
: : : : :
D D M M Y Y Y Y
Nationality :
Pin : Ph. (Res.) with STD Code : Permanent Address : Mobile No. ** :
Pin : Ph. (Res.) with STD Code : School affiliated to Class : : CBSE IX X Board X Board- Science General ICSE XI . % Maths Mobile No. : Other (Please Specify) _______________________ XII XII (Pass) XII Board XII Board- P . C % M
Marks in Sci.+Math/PCM (%) Obtained : Marks (if in Grades) Category of Student E-mail ID of the Student
(in Block Letters)
: : :
** Please mention if you want to receive information through SMS on this mobile:
Yes
No
FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016 PH: 011- 46106000/10/13/15, Toll Free No. 1800 11 4242, Fax: 26525337, 26513942; E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com 1/4
Nearest relative / Guardian Address (to be contacted in case the student is not available at the above mentioned address):
: : :
Particulars
Name Qualification Occupation Designation Company Name Company / Office Address
Father
Mother
Company / Office Tel. No. Mobile No. E-mail (in Block Letters) Annual Income
FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016 PH: 011- 46106000/10/13/15, Toll Free No. 1800 11 4242, Fax: 26525337, 26513942; E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com 2/4
Test Centres$ for All India Test Series (AITS) for JEE (Main & Advanced) (only one centre can be opted): Delhi (South), Delhi (North-West), Delhi (East), Delhi (Dwarka), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Delhi NCR (Gurgaon), Delhi NCR (Noida), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai, Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dehradun, Dhanbad, Durgapur, Gaya, Gorakhpur, Guwahati, Gwalior, Hisar, Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota, Lucknow, Ludhiana, Meerut, Mumbai (Andheri), Mumbai (Chembur), Mumbai (Kandivali), Mumbai (Thane), Muzaffarpur, Mysore, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee, Rourkela, Shaktinagar NTPC, Siliguri, Thrissur, Trivandrum, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Visakhapatnam.
$ Above are the Test Centres for All India Test Series for JEE (Main & Advanced) only. (for centres of Concept Strengthening & Analysis Program (CSAP), please contact your nearest FIITJEE Centres.)
Note: All India Test Series (One Year & Two Year) is also available by Correspondence
(All the Test Papers to be received & attempted at your home.)
Check List (Please tick in the box): 1. Photocopy of X / XII Board Marksheet* VIII school final exam marksheet* (for Junior Rankers Study Material) 2. Colour Photographs (3 Passport Size & 1 Stamp Size) 3. Demand Draft for Course Fee
* In case of claim for scholarship, marksheet / certificate of Scholastic Achievement is to be attested by the past or present School Principal.
Fee of any program is not refundable at any stage. 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. Please write your name behind your Photograph and your name & address behind the Demand Draft. The Demand Draft for course fee for all the above mentioned JEE programs should be in favour of "FIITJEE Limited - TS, RTPF, GMP A/c" payable at New Delhi. Photocopy of this form can also be used.
(Signature of Parent / Guardian) Name _______________________________________________ Relationship with the Student____________________________ Mobile. No. of Parent / Guardian _________________________
FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016 PH: 011- 46106000/10/13/15, Toll Free No. 1800 11 4242, Fax: 26525337, 26513942; E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com 3/4
For JEE (Main & Advanced), 2014 (for Class XII & XII Pass)
I am interested in enrolling for (Tick the appropriate box) Rankers Study Material (One Year Version) Last date to receive completed application
For students of class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad & Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams
I am interested in enrolling for (Tick the appropriate box) Jr. Rankers Study Material Last date to receive completed application
FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016 PH: 011- 46106000/10/13/15, Toll Free No. 1800 11 4242, Fax: 26525337, 26513942; E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com 4/4
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