En r o l m e n t F o r m

(for

Enrolment Number
 Enrolment Form

In order to serve you even better, please share your valuable opinion below

{Pls tick ( ) options relevant to you}

if yes, Name of FIITJEE Faculty : .........................................................................................

if yes, Name of FIITJEE Student : .........................................................................................

His / Her FIITJEE Program Name : .........................................................................................

FIITJEE Study Centre Enrolled at : .........................................................................................

(please specify) : ............................................................................................................................

.............................................................................................................................................................................................

Please Note :
Check the availability of the program at your preferred FIITJEE centre before making a choice.

your Hall Ticket.

Items required to be submitted along with this form :

Six identical passport size colour photographs of the student (One photograph should be pasted on this page, Two on page no. 14 and
Three photographs should be submitted along with this Enrolment Form).
One stamp size photograph (should be pasted on page no. 14).

Admission offer letter (in Original).

Any one of the following documents :

Photocopy of last Board or School Marksheet supported by any Identity Proof of student or

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 Enrolment Form

: ______/______/_____________

(as mentioned on the Hall Ticket) :_______________________________________________

: _________________________________________________________

(refer page no. 13 & 14) : ________________________________________________________________________

(refer page no. 14 & 15) : ________________________________________________________________________

(if applicable) : ________________________________________________________________________

Student’s Name (in Block Letters) : _______________________________________________________________________________________

: ________/_______/___________ :_________________________________________________

: _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

(Mobile) : ____________________________ (with STD Code) : ___________________________________

(if any) : _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ :_________________________________

(Mobile) : ____________________________ (with STD Code) : ___________________________________

: _____________________________________________________________________

: _______________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

: ________________________________________________ : _________________________

: (please specify) : __________________________

: _______________________________________________________________________________________

: ____________________________ : _____________________________________________

: ____________________________ : _________________________________________

: _______________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

: ________________________________________________ : ___________________________

: ________________________________________________ : _________________________

: (please specify) : __________________________

: _______________________________________________________________________________________

: ____________________________ : _____________________________________________

: ____________________________ : _________________________________________

: _______________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

: ________________________________________________ : ___________________________

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 Enrolment Form

(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler)
: ________________________________________________ : ________________________

(please specify) : __________________________

: _______________________________________________________________________________________

: ____________________________ : _____________________________________________

: ____________________________ : _________________________________________

: _______________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

: ________________________________________________ : ___________________________

: _______________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

_________________________________________________________________________________ : _________________________________

(d) Details of the Sibling(s) (if applicable)

: _______________________________________________________________________________________

: ___________________________ (if enrolled with FIITJEE) :_________________________

: _______________________________________________________________________________________

: ___________________________ (if enrolled with FIITJEE) :_________________________

: _______________________________________________________________________________________

: ___________________________ (if enrolled with FIITJEE) :_________________________

PCM /
Board Year of passing / appeared Aggregate Science + Math
Marks (% (%

I II III IV

: _______________________________________
(please refer course fee Annexure)

S. No. Instrument Number Dated Issuing Bank & Branch

Amount

Total

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 Enrolment Form

Annexure “A”

TERMS & CONDITIONS FOR POST DATED CHEQUE(S)

I understand that if my son /daughter / ward withdraws from the Program to which he/she has been admitted
at any point of time or does not attend the Program and thus the seat given to him/her is rendered vacant,

S. No. Cheque No. Dated Issuing Bank

11

13

14

15

16

17

18

19

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 Enrolment Form

Annexure “A”

S. No. Cheque No. Dated Issuing Bank

31

33

34

35

36

37

38

39

41

43

44

45

46

47

48

49

irrespective of any reasons.

: ____________________________________________________

: __________________________ : ______________________________________

: _____________________________________________________ Address : ____________________________________

I have retained photocopy of this document for my reference before submitting it at FIITJEE.

: _________________________________

Place : _________________________________ : ______________________________________

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 Enrolment Form

Annexure “B”

CONSEQUENCES OF DISHONOUR OF POST DATED CHEQUE(s)

with the legal expenses and out of pocket expenses incurred by FIITJEE.

due date of payment of instalment after which my son / daughter / ward shall be debarred from classes without any further notice
and I shall have no claim for refund of fees or any support in studies besides Legal action inter alia action under Section 138 of the

: ____________________________________________________

: __________________________ : ______________________________________

: _____________________________________________________ Address : ____________________________________

_____________________________________________

_____________________________________________

: _________________________________

Place : _________________________________ : ______________________________________

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 Enrolment Form

Annexure “C”

PARENT DATA SHEET

/ Guardian,

The right and accurate feed back of your ward/student will give us an opportunity to understand the student better which will help us

: ______________________________________________________________________________

: ______________________________________________________________________________

: ______________________________________________________________________________

Good Average Below Average Low Unknown

: ____________________________________________________________________________

If no, state why? : ______________________________________________________________________________

: ______________________________________________________________________

(You may attach a blank page if required.)

________________________________________________________________________________________________________

________________________________________________________________________________________________________

11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health

: _________________________________

Place : _________________________________

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 Enrolment Form

Annexure “D”

: _________________________________________________________________________________________

: ___________________________________________________________________________

: ___________________________________________________________________________________________

:
In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be,

or prospective student.

ambiguity.

I/We further declare that the above named student is taking admission in the ____________________________________________
___________________________________________________(course opted for) having considered everything material and on his/her
own sweet will and with the permission of the Father / Mother / Legal Guardian without any coercion from any side.

: ____________________________________________________ : ________________________________________

: __________________________ Address : _______________________________________

: _____________________________________________________ ________________________________________________

: _______________________________ Place : _____________________________

Instruction :

Checklist :

5. Colour Photographs:

(a) Passport size (Six)

7. Admission offer letter (in Original)

8. Any one of the following documents :

(b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student or

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 Enrolment Form

IMPORTANT INFORMATION FOR STUDENTS (and their parents / legal guardians)

no other verbal assurance of any kind is given by FIITJEE.

rigors of preparing for a competitive exam including but not limited to JEE Advanced & JEE Main etc. as the case may be.

what a coaching institute can do for you.

Please do not take admission at FIITJEE if you think FIITJEE is not the best for JEE coaching.

For success in JEE, it is also important to have excellent performance In XII Board Exams. Furthermore, JEE is a different exam where you
will feel lost if you do not focus on fundamentals and/or you do not develop / have high analytical skills. Any amount of effort will be in vain
without high analytical skills. Admission at FIITJEE does not mean that you have high analytical skills. FIITJEE teachers will guide you in such a
way that your fundamentals are strengthened and you can improve your analytical skills tremendously, whether it happens or not will depend
upon you. The only way to develop strong fundamentals & improve your analytical skills & therefore your chances to get through JEE Main /

hard and must be regular in studies. In case, the teachers feel that the student is not working hard, is creating indiscipline in the Institute,
is irregular in attendance or is not responding properly, he/ she may be expelled from the institute. The decision of FIITJEE in this regard

In the end remember, while anyone can appear in JEE Main / JEE Advanced or pretend to prepare but only the ones who walk the right path will
succeed. FIITJEE has no magic potion to make you successful. Preparing to achieve optimum performance in both Boards & JEE will challenge
every bit of your mental & physical energies.

taking admission has to pay complete fee under all circumstances i.e. even if he/she discontinues for any reason whatsoever or parents /

before taking admission as you have to pay complete fee under all circumstances.

has to source infrastructure, faculty etc. in advance, loss of fees of students leaving after taking admission will compel the institute to enhance
fees for next batch of students which is unfair to them. Therefore, students / parents must clearly understand this important aspect and take

3. Any change in government rules, regulations, policies pertaining to the courses of competitive exam such as JEE Main / JEE Advanced,

in any manner whatsoever. However, FIITJEE shall take all necessary steps to protect the interest of students.

: _________________________________ : _________________________________

: __________________________________ : __________________________________

: __________________________________ : __________________________________

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 Enrolment Form

DECLARATIONS / UNDERTAKINGS
Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you

1. I/We hereby declare that the information furnished on this enrolment form etc. is correct to the best of my knowledge and belief.

3. I/We undertake that the information / details furnished / given by me/us are correct and if any discrepancy is found in the said details / information,

to my (student) expulsion from the institute and I/We shall not be entitled for any refund of fees / claim / compensation / damages etc.

commencement of course program. However if I fail to do so, FIITJEE may not allow me to attend the classes, unless otherwise allowed by
FIITJEE in writing. I/We further undertake that I/We shall not claim any refund of fees/ cost of study material etc. already paid on ground of
inability to furnish/complete documents / formalities.

5. I/We understand and acknowledge that FIITJEE does not give any guarantee / promise / assurance for success in JEE Main / JEE Advanced /

I undertake that I shall not hold FIITJEE responsible if I may not succeed the JEE or other competitive exam.

means that some students based on their performance, may have to predominantly focus on exams other than JEE (Main & Advanced).

8. I undertake that if I leave the institute midway before completing the full course for any reason whatsoever, including but not limited to transfer
of my Father / Mother / Legal Guardian / ill health of myself or any other member of the family or my admission in any institute / course /
engineering college etc., or my studentship is cancelled because of misconduct etc., I or my Father / Mother / Legal Guardian shall not be entitled
for refund of fees.

towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student.

13. I/We acknowledge that the course materials provided to the student by FIITJEE during the course of study at FIITJEE are the intellectual property
of FIITJEE and solely for personal purposes and not for commercial use. I further undertake that I shall not make copies of the study material
provided by FIITJEE nor shall provide / give / distribute it to anyone else.

in coping up with huge pressure of simultaneous preparation for competitive exams along with school / board studies. In few cases where some
students do discontinue because they are not able to cope up with simultaneous competitive exam preparations along with school / board
studies, the parents have continued to support the good work of FIITJEE.

periods then his/her teaching will be considered unsatisfactory by high FIITJEE standards.

decided to study only at FIITJEE. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option
(the same is signed by me & the student and is attached with this enrolment form) at our own sweet will and convenience without any pressure
/ coercion from any one.

various Other Engineering Entrance Exam as soon as I/We receive the same from the examining body.

: _________________________________ : _________________________________

: __________________________________ : __________________________________

: __________________________________ : __________________________________

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 Enrolment Form

DECLARATIONS / UNDERTAKINGS
17. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word

I/We shall attend the seminars / workshops / felicitation / interview etc. conducted by FIITJEE after achieving rank by the student; however
FIITJEE shall alone bear the entire cost and expenses in respect thereof. I further undertake to endorse the efforts and contributions made by

the concerned JEE year, FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student /

18. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further
agree to give a letter of appreciation to FIITJEE for the outstanding result in form of a Letter, a Video Interview or any other forum / format that

19. I/We undertake and acknowledge that incase I/We indulge in any kind of litigation with FIITJEE, I/We shall not be entitled for any Awards /

student, within a period of 15 days, failing which FIITJEE shall be entitled to recover the same through the appropriate court / forum alongwith
interest, damages and cost of litigation.

cause loss of property, reputation and goodwill of FIITJEE. I/We further undertake that I/We shall compensate for/ indemnify against any
loss /damage caused to FIITJEE.

the student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and

Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.

everything material, on his/her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission

taking admission in FIITJEE, the matter shall be referred to the Sole Arbitrator appointed by FIITJEE Ltd. The arbitration proceedings shall

not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or Group / Subsidiary Companies, and for reasons

future reference and timely compliance.

: _________________________________ : _________________________________

: __________________________________ : __________________________________

: __________________________________ : __________________________________

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 Enrolment Form

DECLARATIONS / UNDERTAKINGS

have any Local Guardian)

As my Father / Mother / Legal Guardian do(es) not reside at _______________________________________ and I have no Local
Guardian. I own all responsibility on their / his / her behalf.

: _________________________________ : ________________________________

: _________________________________ : _______________________________________________

(To be struck off, if Not Applicable)

I have received an extra copy of this Enrolment Form, which I shall send to my Father / Mother / Legal Guardian and submit to
FIITJEE within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities
in writing, my admission shall be liable to be cancelled and I or my Father / Mother / Legal Guardian shall have no claim for refund
of fees or any other compensation of any type.

: _________________________________ : ________________________________

: _________________________________ : _______________________________________________

(To be struck off, if Not Applicable)

Check list for the Accountant / Admission Coordinator.

: _____________________________________________________________

The details of the scholarship offered.

o Cash scholarship (If any) : _______________________________________________________________________________

o Fee Waivers offered (If any) : ___________ ____________________________________________________ ground

o Hostel fee waiver (If any) : ______________________________________________________________________________

6 passport size and one stamp size photograph are attached.

Late payment charges / Admin. charges duly calculated and collected.

The student has been offered the admission after selection in Admission test only.

: _______________________ Place : _________________________ Signature of the Account / Admission Coordinator

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 Enrolment Form

Classroom / Integrated School Programs

Program
Program Name
Code
For Admission in Class 6th

LITTLE GENIE - One Year Foundation Program - Regular Week Contact Classes 6051

LITTLE GENIE - One Year Foundation Program - Weekend Contact Classes 6052

LITTLE GENIE - One Year Foundation Program - Sunday Contact Classes 6053

For Admission in Class 7th

UDAYA Plus - Two Year Integrated School Program 7010

UDAYA - Two Year Classroom Program - Regular Week Contact Classes 7051

UDAYA - Two Year Classroom Program - Weekend Contact Classes 7052

UDAYA - Two Year Classroom Program - Sunday Contact Classes 7053

For Admission in Class 8th

UDAYA - One Year Classroom Program - Regular Week Contact Classes 8051

UDAYA - One Year Classroom Program - Weekend Contact Classes 8052

UDAYA - One Year Classroom Program - Sunday Contact Classes 8053

For Admission in Class 9th

SUPREME - Four Year Integrated School Program for JEE Advanced 9020

ATHENA - Four Year Integrated School Program for JEE Main 9022

Four Year Classroom Program for JEE Advanced - Regular Week Contact Classes 9061

Please submit
Four Year Classroom Program for JEE Advanced - Weekend Contact Classes 9062
3 additional passport
Four Year Classroom Program for JEE Advanced - Sunday Contact Classes 9063 size colour photographs
with this
Four Year Classroom Program for JEE Advanced - Regular Week Contact Classes (Admission only for Class IX and X) 9064 Enrolment Form

Four Year Classroom Program for JEE Advanced - Weekend Contact Classes (Admission only for Class IX and X) 9065

Four Year Classroom Program for JEE Advanced - Sunday Contact Classes (Admission only for Class IX and X) 9066

Four Year Classroom Program for JEE Main - Regular Week Contact Classes 9071

Four Year Classroom Program for JEE Main - Weekend Contact Classes 9072

Four Year Classroom Program for JEE Main - Sunday Contact Classes 9073

For Admission in Class 10th

Three Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1061

Three Year Classroom Program for IIT-JEE - Weekend Contact Classes 1062

Three Year Classroom Program for IIT-JEE - Sunday Contact Classes 1063

Three Year Classroom Program for JEE Advanced - Regular Contact Classes (Admission only for Class X) 1064

Three Year Classroom Program for JEE Advanced - Weekend Contact Classes (Admission only for Class X) 1065

Three Year Classroom Program for JEE Advanced - Sunday Contact Classes (Admission only for Class X) 1066

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 Enrolment Form

Classroom / Integrated School Programs

Program
Program Name
Code
For Admission in Class 11th

PINNACLE - Two Year Integrated School Program for IIT-JEE 1110

PINNACLE - Two Year Integrated Program for IIT-JEE (Jr. College) 1112

Two Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1151

Two Year Classroom Program for JEE Advanced - Weekend Contact Classes 1152

Two Year Classroom Program for JEE Advanced - Sunday Contact Classes 1153

Two Year Classroom Program for JEE Advanced - Special Weekend Contact Classes 1154

Two Year Classroom Program for JEE Advanced - Regular Week + Sunday Contact Classes 1155

Two Year Classroom Program for JEE Main - Regular Week Contact Classes 1171

Two Year Classroom Program for JEE Main - Weekend Contact Classes 1172

Two Year Classroom Program for JEE Main - Sunday Contact Classes 1173

Two Year Classroom Program for JEE Main - Special Weekend Contact Classes 1174

Two Year Condensed Classroom Program for IIT-JEE -Regular Week Contact Classes 1161

Two Year Condensed Classroom Program for IIT-JEE -Weekend Contact Classes 1162

Two Year Condensed Classroom Program for IIT-JEE - Sunday Contact Classes 1163

For Admission in Class 12th

One Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1251

One Year Classroom Program for JEE Advanced - Weekend Contact Classes 1252

One Year Classroom Program for JEE Advanced - Sunday Contact Classes 1253

One Year Classroom Program for JEE Advanced - Regular Week + Sunday Contact Classes 1254

One Year Classroom Program for JEE Main - Regular Week Contact Classes 1271

One Year Classroom Program for JEE Main - Weekend Contact Classes 1272

One Year Classroom Program for JEE Main - Sunday Contact Classes 1273

One Year Classroom Program for JEE Main - Regular Week + Sunday Contact Classes 1278

Special One Year Weekend Classroom Program 1261

Special Weekend Classroom Program for IIT-JEE 1262

Intensive Contact Program for JEE Advanced 1264

Special One Year Classroom Program for JEE Main & Advanced 1266

Intensive Contact Program for IIT-JEE 1281

Super Rank Enhancement Classroom Program for IIT-JEE 1282

Crash Course for JEE Main 1286

For Admission After Class 12th

One Year Extended Classroom Program for JEE Advanced - Regular Week Contact Classes 1351

One Year Classroom Program for JEE Main - Regular Week Contact Classes 1371

One Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1361

Special Classroom Program (for Ex-FIITJEEians) 1362

Intensive Contact Program for IIT-JEE 1381

Super Rank Enhancement Classroom Program for IIT-JEE 1382

Crash Course for JEE Main 1386

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