Enrolment No.

:
(For official use only)

(To be filled by the student)



Name of the Student :

Fathers/Guardians Name :

Mothers Name :

Date of irth : Nationality :

!orres"onden#e $ddress :



%in :

%h. (&es.) 'ith STD !ode : Mobile No. (( :

%ermanent $ddress :



%in :

%h. (&es.) 'ith STD !ode : Mobile No. :

S#hool affiliated to : !SE )!SE *ther (%lease S"e#ify) _______________________

!lass : )+ +) +)) +)) (%ass)

Mar,s in S#i.-Math/%!M (.) *btained : + oard . . +)) oard . .

Mar,s (if in Grades) : + oard/ S#ien#e Maths +)) oard/ % ! M

!ate0ory of Student : General *ther (%lease s"e#ify) ____________________________

E/mail )D 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, Sara!riya "i#ar, Ne$ %el#i&''( (')
*#+ (''& ,)'()((( -'( - '. - '/- )0, All In1ia Toll Free No2 '0(( '' ,2,2, Fa3+ (''& 2)/'.9,2
E&4ail+ 5uery21is!a6c#7fii68ee2co4, $e9si6e+ $$$2fii68ee2co4
1/2
%referen#e of Test !entre
for $)TS for 3EE (Main 4 $d5an#ed) :
(for lis6 of Tes6 :en6res see !a;e no2 .)
Name of %ro0ram Enrollin0 for :
(for lis6 of *ro;ra4s see !a;e no2 ,)
!orres"onden#e %ro0rams
EN&*6MENT F*&M



*lease Affi3 Your
<ecen6 *ass!or6 Si=e
:olour *#o6o;ra!#






D D M M 7 7 7 7



























































Nearest relati5e / Guardian $ddress (to be #onta#ted in #ase the student is not a5ailable at the abo5e mentioned address):




%in :

%h. (&es.) 'ith STD !ode : Mobile No. :


Name of the S#hool :
(s6u1yin; or !asse1)
Name of the %rin#i"al :

S#hool $ddress :




%in :

%hone No.:


Details about your %arents:
%arti#ulars Father Mother
Name
8ualifi#ation
*##u"ation
Desi0nation
!om"any Name
!om"any / *ffi#e $ddress








!om"any / *ffi#e Tel. No.
Mobile No.
E/mail (in lo#, 6etters)
$nnual )n#ome

FIITJEE House, 29 A, Kalu Sarai, Sara!riya "i#ar, Ne$ %el#i&''( (')
*#+ (''& ,)'()((( -'( - '. - '/- )0, All In1ia Toll Free No2 '0(( '' ,2,2, Fa3+ (''& 2)/'.9,2
E&4ail+ 5uery21is!a6c#7fii68ee2co4, $e9si6e+ $$$2fii68ee2co4
9/2






























Test !entres
:
for $ll )ndia Test Series ($)TS) for 3EE (Main 4 $d5an#ed) (only one centre can be opte):
%el#i (Sou6#), %el#i (Nor6#&>es6), %el#i (Eas6), %el#i (%$ar?a), %el#i N:< (Fari1a9a1), %el#i N:< (@#a=ia9a1), %el#i N:< (@ur;aon),
%el#i N:< (Noi1a), A;ra, A#4e1a9a1, A84er, Alla#a9a1, A4ri6sar, Auran;a9a1, Aan;alore, Aareilly, Aa6#in1a, A#a;al!ur, A#ilai,
A#o!al, A#u9anes$ar, Ao?aro, :#an1i;ar#, :#ennai, %e#ra1un, %#an9a1, %ur;a!ur, @aya, @ora?#!ur, @u$a#a6i, @$alior, Hisar,
Hy1era9a1, In1ore, Ja9al!ur, Jai!ur, Ja44u, Ja4s#e1!ur, J#ansi, Jo1#!ur, Kan!ur, Karnal, K#ara;!ur, Koc#i, Kol?a6a, Ko6a,
Buc?no$, Bu1#iana, Ceeru6, Cu49ai (An1#eri), Cu49ai (:#e49ur), Cu49ai (Kan1iali), Cu49ai (Nai Cu49ai), Cu49ai
(T#ane), Cu=affar!ur, Cysore, Na;!ur, *a6iala, *a6na, *une, <anc#i, <o#6a?, <oor?ee, <our?ela, S#a?6ina;ar NT*:, Sili;uri, T#rissur,
Trian1ru4, D1ai!ur, D88ain, "a1o1ara, "aranasi, "i8aya$a1a E "isa?#a!a6na42
! "bove are the #est $entres for "ll %nia #est Series for &'' (Main ( "vance) only)

Note: "ll %nia #est Series (*ne +ear ( #wo +ear) is also available by Correspondence
("ll the #est Papers to be receive ( attempte at your home))



!ourse Fee "ayment details :
Demand Draft No. Dra'n on an, Dated $mount





!he#, 6ist (Please tick in the box):
'2 *#o6oco!y of
F - FII Aoar1 Car?s#ee6G
"III sc#ool final e3a4 4ar?s#ee6G (for Junior <an?ers S6u1y Ca6erial)
22 :olour *#o6o;ra!#s (, *ass!or6 Si=e)
.2 %e4an1 %raf6 for :ourse Fee

* %n case of claim for scholarship, marksheet - certificate of Scholastic "chievement is to be atteste by the past or present School Principal)



Note 1: .ee of any program is not refunable at any stage)
Note 2: "ll %nia #est Series is part of /ankers Stuy Material) +ou nee not enrol for it separately in case you are enrolling yourself for /ankers Stuy Material)
Note 3: Please write your name behin your Photograph an your name ( aress behin the 0eman 0raft)
Note 4: #he 0eman 0raft for course fee for all the above mentione &'' programs shoul be in favour of 1.%%#&'' Limite 2 #S, /#P., 3MP "-c1 payable at
4ew 0elhi)
Note 5: Photocopy of this form can also be use)






*lace+ ______________ (Si;na6ure of 6#e S6u1en6) (Si;na6ure of *aren6 - @uar1ian)

%a6e+ ______________ Na4e _______________________________________________

<ela6ions#i! $i6# 6#e S6u1en6____________________________

Co9ile2 No2 of *aren6 - @uar1ian _________________________


FIITJEE House, 29 A, Kalu Sarai, Sara!riya "i#ar, Ne$ %el#i&''( (')
*#+ (''& ,)'()((( -'( - '. - '/- )0, All In1ia Toll Free No2 '0(( '' ,2,2, Fa3+ (''& 2)/'.9,2
E&4ail+ 5uery21is!a6c#7fii68ee2co4, $e9si6e+ $$$2fii68ee2co4
;/2
For 3EE (Main 4 $d5an#ed)< 9=1> (for Class X ! X Pass)
) am interested in enrollin0 for (Ti#, the a""ro"riate bo?) 6ast date to re#ei5e #om"leted a""li#ation
<an?ers S6u1y Ca6erial ("ne #ear $ersion) .'s6 Au;us6, 2(',
Hne Year All In1ia Tes6 Series 06# Noe49er, 2(',
Hne Year All In1ia Tes6 Series (%y Correspondence) '/6# Noe49er, 2(',



For 3EE (Main 4 $d5an#ed)< 9=1@ (for Class X)
) am interested in enrollin0 for (Ti#, the a""ro"riate bo?) 6ast date to re#ei5e #om"leted a""li#ation
<an?ers S6u1y Ca6erial (&'o #ear $ersion) 2(6# Se!6e49er, 2(',
T$o Year In6e;ra6e1 All In1ia Tes6 Series 296# Noe49er, 2(',
T$o Year In6e;ra6e1 All In1ia Tes6 Series (%y Correspondence) )6# %ece49er, 2(',



For students of #lass )+ as"irin0 to e?#el in )+< +< 3r. S#ien#e *lym"iad / Math *lym"iad
4 Foundation 3EE (Main 4 $d5an#ed) / AB%7 / NTSE / *ther !om"etiti5e E?ams
) am interested in enrollin0 for (Ti#, the a""ro"riate bo?) 6ast date to re#ei5e #om"leted a""li#ation
Jr2 <an?ers S6u1y Ca6erial 2(6# Se!6e49er, 2(',











FIITJEE House, 29 A, Kalu Sarai, Sara!riya "i#ar, Ne$ %el#i&''( (')
*#+ (''& ,)'()((( -'( - '. - '/- )0, All In1ia Toll Free No2 '0(( '' ,2,2, Fa3+ (''& 2)/'.9,2
E&4ail+ 5uery21is!a6c#7fii68ee2co4, $e9si6e+ $$$2fii68ee2co4
2/2
(
0
(
'
2
(
'
,