Registration Form

For Office use onlyVibrant Roll No. If Pay by DD then Attach DD of Rs. 1000 /- in favour of Vibrant Academy India Pvt. Ltd. Payable at Kota (Raj.). Write UId, Candidate Name, Address and Mobile no at the back of DD If Pay online Click here Course Name : Googol UId 72934 Phase IV Test Center (1st Direct 2. Direct Choice) Date Of Birth 03 Oct 95 Gender : Male Student Name BOOB AADITYA SANJAY Mother Name HEMLATA BOOB Father Name SANJAY BOOB Father Occupation Business Designation PARTNER Deptt. PRIVATE 101,GANGA GITANJALI APT, CRESCENT HIGH Permanent Address SCHOOL LANE, GULTEKDI City PUNE State Maharashtra411037 Email aaditya733@gmail.com Phone 02024262484 Mobile(Student) 7709119333 Mobile(Father) 9881375124 NTSE II Last Class XII No Stage. NTSE Stage * Not Applicable Category Gen
* NTSE second stage qualified. Please Attach proof Class IX X XI School Year Board Maharashtra Board Maths Sci 96 75 PCM NA NA 58.33 80 Aggr 75.5 89.09 60.33 84.83

Crescent High School 2010 Crescent High School 2011 P.Jog College 2012 2013

Maharashtra 97.33 98 Board Maharashtra Board Maharashtra Board NA NA NA NA

XII P.Jog College

Mention the performance of previous competitive examination, if Any

if pay by DD then DD Details

DD No. : Bank Name : ______________________________ __________________________________________ ______ _____ DD Amount : DD Date : ______________________________ __________________________________________ __ ________ If Pay Online then write Receipt No. Receipt No. : ___________________________________ Students must submit attested copy of relevant document as proof.
Signature(Applicant) with Date Signature(Father/Guardian) with Date

Paste latest Passport Size Colour Photograph

Refund Rules
A. Registration form fee : Registration form fee of Rs Rs 1000/- is not refundable under any circumstance whether you appear for selection test or not. Those sending the Demand Draft for obtaining registration form will write their complete and clear postal address with PIN code to avoid the postal delay. Students will ensure to appear for the selection test on centre mentioned on registration form. If student does not appear for the selection test for any reason the registration form fee will not be refunded. For any discrepancy before selection test date student will call up our office for clarification. B. Course Fee : In case you do not join our course after your selection and payment of first installment of Fee for any reason and claim refund of Fee before commencement of course 90% of First Installment of Basic Fee will be refundable. In case you discontinue our course due to some reason or the other, fee will be refunded on submission of application in prescribed form, duly filled ,in the office .No request on Mail, Fax, SMS telephone or any other mode will be entertained. Refund will be made as per following:-

From the date of commencement of course i.e. Micro Course 29.04.2013 Mega Course 03.04.2013

General Rules Mention your Correct E-mail Address, while filling application form.. Please keep visiting our web site at regular intervals to keep yourself updated with the current happenings & your academic performance. Student will attend their classes in their own batches; non compliance of this will result into suspension for one week and loss of studies will not be compensated. Incase you dont receive the admit card by post, you can download the same from our website 4 days prior to the test date. If the student indulges

Nano Course 03.06.2013 01.05.2013 (Phase-I), Googol 10.06.2013 (Phase-II), Course 01.07.2013 (Phase-III) 01.05.2013 (Phase-I), Googol 10.06.2013 (Phase-II), (Main) course 01.07.2013 (Phase-III) IRP Course 15.04.2013 Refund will be given as following 85% of 1st installment Within a of basic fee week From 1st 75% of 1st installment week to 2nd of basic fee week From 2nd 50% of 1st installment week to 4th of basic fee week From 5th 25% of 1st installment week to 6th of basic fee week From 7th 10% of 1st installment week to 8th of basic fee week
And no refund thereafter No refund is allowed out of 2nd installment of fee amount. Amount paid by you as taxes will not be refunded. Date of fee refund is universal even if you join late or do not attend even a single class. The fee refund will be made in form of Account Payee cheque only in favour of the students father ( in case father is not alive then it shall be made in the name of mother or in case if both are not alive then it shall be made in the name of guardian in blood relation) The fee refund cheque will be sent by registered post /courier at his/her permanent address or the address given by him/her in the refund application . In case a student is involved in an incident of indiscipline at any point of time and rusticated by the institute, no refund of fee will be applicable in such a case. Any legal matter/dispute related to fee refund is subject to Kota City (Rajasthan) Jurisdiction only.

in any kind of unfair or unsocial activity, it is the responsibility of the student and his parent only. The institute bears no responsibility for the same. Commutation to institute will be the sole responsibility of the student. If any mishap occurs during travelling to the institute it is solely the responsibility of the student. Medium of instruction is English only and all literature provided by us is solely in English. Signature of applicant and father / guardian on both sides of registration form is must, otherwise form will be rejected. Students found using mobile inside the campus will be fined as : First Time Rs. 200/-, Second Time Rs 300/-, Third Time Rs. 1000/- and after that Mobile will be forfeited. Please save your time by checking your registration status on our website. Getting a telephonic reply in this regard may be time consuming due to rush on telephone line. Loss of I-card will incur a fine of Rs.200/-. In case any student is

found seeking admission by fraudulent means he / she will be removed from the rolls of the Institute immediately and no refund of fee/caution money etc will be made under any circumstances. We reserve the right to delete any course and deny for admission without assigning any reason. Declaration: We have read the Refund Rules as well the General Rules and agree to abide by them.

Signature(Applicant) with date

Signature(Father/Guardian) with date

You are advised to retain a photocopy of duly completed Registration Form for your records

ADMIT CARD
Reg No. : Course Applied For : Googol Phase IV Name
[In Block Letters] BOOB AAD I T YA SANJAY [As in application form] Affix latest Passport Size Colour Photograph

Father's Name S A N J A Y B O O B
[In Block Letters]

FOR OFFICE USE ONLY Test Center

Entrance Test Date & Timings

For Vibrant Academy(I) Pvt. Ltd. Authorised Signature

Regd. Office: Vibrant Academy(I) Pvt. Ltd. Vibrant Tower : A-14(A), Road No.1, Indraprastha Industrial Area, Kota -324005 (Raj.) India Tel No.: 0744-2423406, 2428664, 2428666, 3205261, 3205262, DLP Help Line No. : 0744-3205261, Fax:0744-2423405 Website: www.vibrantacademy.com E-mail: admin@vibrantacademy1.com

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