ADMISSION FORM FOR CLASSROOM/HYBRID COURSE

☑ I understand and agree that the personal information will be collected by Aakash Educational Services
Limited (“Company”) while submitting the admission form and the personal information may be used or
stored by the Company as mentioned under the Company’s Privacy Policy. I have read and agree to the
Company’s Privacy Policy in it’s entirety

Form Filled by Guardian and I agree that at the time of filling the admission form my age is 18 or above.

PSID: Branch
00010506651 Darbhanga Branch

Stream: Term
Medical 2324

Course Name Batch Option

OY Regular Medical Course NEET Weekdays-Morning
Hindi Medium Phase 2 - 720229

Personal Detail

Student Name: Dipti Rani

Date of Birth 06/02/2006
Gender Female
Category GENERAL
Student Email ID : dipti1dbg@gmail.com
Primary Mobile No. 9155337708
Secondary Mobile No. : 8294493199
Father’s Name : Santosh Roy
Mother's Name Ranjeeta Devi
Parent's/Guardian's Occupation : Service
Nationality : India
Blood Group : AB+

Address Details

Correspondence Address

Address: Bhatiyarisarai
Pincode: 846004
State: Bihar
City : Darbhanga
Phone No :
Parent's Email ID : dipti1dbg@gmail.com

Permanent Address

Address:
Pincode:
State:
City:
Phone No:

Education Detail

Class Studying: 12+

Exam Board: STBD
School State: Bihar
School City: Darbhanga
School Name:
Marks Obtained in last class %: %
Grades Obtained in last class: Math :

Science :

Original marksheet of the last board or equivalent exam

Copy of Identity Card issued by Aakash

Date: 05-05-2023
☑ I hereby authorize the Company and/or its service provider(s) to reach out with transactional/promotional/
other information on my coordinates (whatsapp/ email/ mobile number)
☑ I hereby acknowledge that the information and/or documents provided by me are correct and true. In case of
any discrepancies in the information provided by me, Company shall reserve the right to cancel/reject my
application form
☑ I hereby read, understood and agree the terms and conditions of the Company.

The details of the admission form has been verified by the customer through OTP authentication
on mobile number 9155337708 and 8294493199 at 05-05-2023 11:32:04 at 106.216.121.32