Candidate Application Form

Student Name – SHAKIB KHAN

Guardian’s Name—MUSTAFA KHAN

Guardian’s Occupation - Business

Family’s Annual Income – Rs.5 lakhs only

Contact Person Name [of Amfinity]-Avinit Saha

School –Government High School, Kesaria, East Champaran

Category –General

Date of Admission –

Stream Interested – Bachelor in Pharmacy

College Interested –Guru Nanak Institute of Pharmaceutical Science and Technology

Contact- Details –

Permanent Address –M-97,singer hatty taratalla road kolkata -700024

Post office- Garden reach

Residential Address –M-97,singer hatty taratalla road kolkata -700024

Post office- Garden reach

Mobile Number –8443059688

E-Mail –Khanshahbaz121@gmail.com

Documents Submited—

1. Photocopy of 10th Marksheet

2. Photocopy of 12th Marksheet
3. Photocopy of Entrance Rank Card

I do hereby authorize Amfinity Solutions LLP to act on my behalf as the Educational or Career Consultant
and provide us [candidate and guardian] with their services of Admission Assistance for the successful
admission of my Candidate___________________________ under my Guardianship, for successful
admission in 2019 at the above mentioned courses under the colleges by us [candidate and guardian] ,
or under the verbally suggested colleges by Amfinity Solutions or us [candidate and guardian] and
Agreed by us [candidate and guardian]. For the Admission Assistance of my candidate, I agree to pay INR
1.5k as the Consultancy Fees to Amfinity Solutions LLP, either by cash to the contact person mentioned
above or via bank transfer.

I do hereby authorize Amfinity Solutions LLP to act as the Educational or Career Consultant, and provide
us [candidate and guardian] with their services of Admission Assistance for my successful admission in
2019 at the above mentioned courses under the colleges by us [candidate and guardian], or under the
verbally suggested colleges by Amfinity Solutions or us [candidate and guardian] and Agreed by us
[candidate and guardian]. For my Admission Assistance, I agree to pay INR 1.5k as the Admission
Assistance Fees to Amfinity Solutions LLP, either by cash to the contact person mentioned above or via
bank transfer.

__________________________
Signature of Candidate with Date ________________________
Signature of Guardian with Date and Place
Note – Payment Made to Amfinity Solutions LLP are non refundable. Please co-operate with the
Contact Person and Follow the instructed way to Amfinity Solutions LLP for successful Admission of
the Candidate. Amfinity Solutions will try it’s best to provide you legally with the best service you
could have from the company.

__________________________
Signature of Candidate with Date ________________________
Signature of Guardian with Date and Place