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.in

Acknowledgement & Declaration Form (Session 2024-25 )

Application form no: 1003444190 Photograph

Name of Applicant: Aditya Agrawal

Father's Name: Nitin Agrawal
Mother's Name: Nitu Agrawal
Gender: Male Medium: English
Stream: Jee (Main + Advanced)
Center: KOTA
Course Name: NURTURE PHASE-I / 101001
358/A Samta Colony Beside Dr. Sk. Goyal Hospital Main Road
Address: City: Raipur ,
District: Raipur , State: Chhatisgarh , Pin: 492001
Contact Details: Phone No.: 0771 - 4221284 Mobile No: 9893791917
Email: nkaraipur@gmail.com
Account Creation Date &
Jan 3 2024 8:13PM
Time:
Profile Creation Date &
Jan 3 2024 8:16PM
Time:
Online Application Form
Jan 3 2024 8:33PM
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:03-Jan-2024 20:44:10