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: 1000605109 Photograph

Name of Applicant: Harshit

Father's Name: Bhim Shah
Mother's Name: Manju Shah
Gender: Male Medium: English
Stream: Jee (Main + Advanced)
Center: SIKAR
Course Name: NURTURE PHASE-II / 101002
Ward No 29, Near Royal Residency Karundia Road Jhunjhunu
Address: City: Jhunjhunu ,
District: Jhunjhunu , State: Rajasthan , Pin: 333001
Contact Details: Phone No.: - Mobile No: 6376205559
Email: harshitshah622@gmail.com
Account Creation Date &
Apr 11 2023 8:35PM
Time:
Profile Creation Date &
Apr 13 2023 12:02PM
Time:
Online Application Form
Apr 13 2023 12:10PM
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:16-Apr-2023 19:26:08