ALLEN Career Institute Pvt. Ltd.

Corporate Office:
“SANKALP”, CP-6, Indra Vihar, Kota, (Rajasthan) - 324005
Ph.: +91-744-275-7575
Website: www.allen.ac.in | E-mail: info@allen.ac.in

Acknowledgement & Declaration Form (Session 2023-24 )

Application form no: 1000548415 Photograph

Name of Applicant: Pari Shah

Father's Name: Darpan Shah
Mother's Name: Margi Shah
Gender: Female Medium: English
Stream: Pre-Nurture
Center: VADODARA, MEMORIES BUILDING, AKOTA
Course Name: CLASS VIII PHASE-I / 404011
28 Chitrakut Society, Waghodia Road Waghodia Road
Address: City: Vadodara ,
District: Vadodara City , State: Gujarat , Pin: 390019
Contact Details: Phone No.: - Mobile No: 9099847777
Email: parishah10122009@gmail.com
Account Creation Date &
Mar 16 2023 12:52PM
Time:
Profile Creation Date &
Mar 16 2023 1:11PM
Time:
Online Application Form
Mar 16 2023 1:51PM
Fee Deposit Date & Time:

Declaration
I hereby declare
that I am seeking admission in my own interest and accord.
that I shall be fully responsible for any accident / mis-happening occurring with me/by me inside / outside the institute's
premises and institute will not responsible in any manner.
that I shall be responsible for my rustication on grounds of misconduct, misuse of mobile phones, misuse of internet or any
illegal and indecent activity.
that in case of my selection in Medical / Engineering Entrance Exams / NTSE & Olympiads, the institute reserves the right to
use my name, photo and other information for publicity purpose.
that I solemnly affirm that the institute has rights to send me emails (e-newsletters), sms alerts, WhatsApp Messages (Text,
Images, Video, Documents) and post on the mentioned communication details.
that all the information furnished by me in the ONLINE Application Form or in any other form etc. is correct to the best of my
knowledge. I understand that in the event of any information found to be incorrect or false, my admission may be cancelled
without any refund of fee.
that I have read all the instructions of the Information Bulletin / available Online and I do agree to follow the instructions as
applicable.
that I agree to abide by the Refund Rules of the Institute.
I agree that all dispute are subject to Kota (Rajasthan) jurisdiction only.

Registered & Corporate Office : “SANKALP”, CP-6, Indra Vihar, Kota (Rajasthan) - 324005
CIN: - U80100RJ2021PTC077131

Note: This is a computer generated document hence no signature required. Print Date:24-Mar-2023 13:39:35