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 Parent and I agree that at the time of filling the admission form my age is 18 or above.

PSID: Branch
00012696109 Kharagpur Franchise

Stream: Term
Medical 2426

Course Name Batch Option

TY Phase 1 Two Year Integrated Weekdays-Morning
Classroom Course for NEET -
720456

Personal Detail

Student Name: SAYAK BAR

Date of Birth 26/03/2008
Gender Male
Category SC
Student Email ID : sayakbar11@gmail.com
Primary Mobile No. 7586076987
Secondary Mobile No. : 7908242644
Father’s Name : Swapan Bar
Mother's Name Keya Bar
Parent's/Guardian's Occupation : Service
Nationality : India
Blood Group : B+

Address Details

Correspondence Address

Address: Jhargram Near Jhargram Railway station, Jhargram,

West Bengal
Pincode: 721507
State: West Bengal
City : West Midnapore
Phone No : 7908242644
Parent's Email ID : swapanbar318@gmail.com

Permanent Address

Address: Jhargram Near Jhargram Railway station, Jhargram,

West Bengal
Pincode: 721507
State: West Bengal
City: West Midnapore
Phone No: 7908242644

Education Detail

Class Studying: 11
Exam Board: CBSE
School State: West Bengal
School City: Medinipur
School Name: WEST END HIGH SCHOOL
Marks Obtained in last class %: 76%
Grades Obtained in last class: Math :

Science :

Original marksheet of the last board or equivalent exam

Copy of Identity Card issued by Aakash

Date: 08-03-2024
☑ 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 7586076987 and 7908242644 at 08-03-2024 19:14:02 at 202.142.69.191