NARAYANA

INSTITUTE OF CORRESPONDENCE COURSES

ADMISSION FORM
Please Tick (3) the program given below:
IIT-JEE: (1Yr) IIT-JEE: (2Yr) NEET: (1Yr) NEET: (2Yr) AIEEE: FOUNDATION:

For Office use only

Enrolment No : ___________________
Scholarship : ___________________
Authorized Signatory : ___________________ Passport Size
photograph
Course Applied for :

Preference of Test Centre :

The form is to be filled in CAPITAL LETTERS only

1. Name of Student :

2. Date of Birth : SEX : ( M / F ) Category ( SC/ST/OBC/GEN )

3. Father's / Guardian Name :

Off. Phone Mobile

4. Mother's Name :

Off. Phone Mobile

5. Address for Correspondence :

City
State Pin
6. Contact Number : Std Code No.

7. Permanent Address :

City
State Pin
8. Contact Number : Std Code No.

9. Email ID of the student :

10. Name of the school/college from where the student has appeared / is appearing for class X / XI / XII

11. Percentage of marks : % (VIII Sci & Maths aggregate) % (IX Sci & Maths aggregate)

obtained in (fill only one) : % (X board Sci & Maths aggregate)

: % (XI board Sci & Maths aggregate) % (XII Sci & Maths aggregate)
12. School affiliated to : CBSE ICSE Other Please specify ______________________
Medium ( ) : English Hindi

For Office Use only

Cash / DD: _______________________ Amount: ___________________________ Drawn on ____________________
Dated: __________________________ off Receipt No: ____________________ Receipt Date: ________________
Hindi
Total Fee: __________ Committed fee: _____________ Fee paid :_____________ Balance Amount :______________
Test Centre: [Please tick (3)]

South Delhi North Delhi West Delhi East Delhi Agra

Aligarh Aurangabad Bhilai Bhubaneswar Dehradun
Faridabad Gurgaon Jamshedpur Kota Noida
Patna Surat/Hazira Allahabad Bhagalpur Bhopal
Chandigarh Kanpur Kolkata Lucknow Ranchi
Bangalore Chennai Trivandrum Ahmedabad Mumbai
Vadodara Shimla Guwahati Dhanbad Mau/Varanasi

TERMS & CONDITIONS

Please read carefully the clauses of the declaration in the enrolment form:
1. In complete form will be rejected.
2. The responsibility to ensure that a student is eligible for a certain examination lies with the student. Similarly, the institute
cannot be held responsible if a student does not submit his/her form with the examining body; or his/her form is rejected
by the examining body for any reason whatsoever. Such student cannot claim refund of the whole or any part of the fee
paid to the Narayana Institute.
3. It is compulsory to attach 3 passport size colored photographs along with the form. Institute reserves the right to use the
students photograph for publicity in case student secures position in IIT‐JEE, Medical Entrance Examinations or AIEEE.
4. Students enrolled with Narayana Institute of Correspondence Course have to submit photocopy of admit cards of all the
Entrance Examinations whichever they are appearing for as soon as they receive their admit cards from the examining
body.
5. Narayana Institute of Correspondence course reserves the right to make any alterations in its programmes / fee without
any prior notice.
6. Any change of address, and/or phone number should be notified to the office without delay.
7. If at any point of time, the central govt. future increase service tax, (existing rate of service tax is 12.36%) the extra amount
of service tax will be borne by the students from the date of enforcement of the act by Govt.
8. The right to add a centre or cancel a centre remains solely with Narayana Institute of Correspondence Courses.
9. In the event of any dispute or diffence as to the terms and conditions of enrolment form or any claim or demand the
dispute and difference will be referred to the Sole Arbitrator clause we will not approach any other
court/forum/commission/settlement authority other than those established in Delhi/New Delhi.
10. I/We undertake that in case the matter is beyond the purview of arbitration clause we will not approach any other
court./forum/commission/settlement authority other than those established in Delhi/New Delhi.
11. Once enrolled for any program, the fee paid is non‐refundable as well as non‐adjustable in any other program.
12. Check list:
(a) Three recent passport size colored photographs.
(b) Mark sheet photocopy of last Board Examination
(c) Demand Draft/Pay Order to be made in favour of “NARAYANA COACHING CENTRE" payable at Hyderabad.
(d) No cash/cheque is acceptable under any circumstances.
I have read and understood the above‐mentioned terms and conditions and agree to abide by the same.

Signature of Parent / Guardian Signature of Student

Date : __________________ Date : __________________

NARAYANA INSTITUTE OF CORRESPONDENCE COURSES

Plot No: 782, Ground Floor, Raada Residency, 100 ft Road, Ayappa Society, Madhapur,
Hyderabad - 500081. Andhra Pradesh
Mobile no: 09912717900 Website: www.narayanaicc.com E - mail: info@narayanaicc.com