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VPM Classes Application Form

This document is an application form for various test preparation courses offered by VPM Classes. The form requests personal information such as name, date of birth, address, contact details, educational qualifications and details of the entrance exam and subject for which the applicant wants to enroll. It also includes details of payment such as account numbers and instructions for submitting the completed form along with required documents and payment. The applicant must declare that the information provided is accurate and agrees to the terms of registration.

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Prashanth Kumar Reddy
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147 views1 page

VPM Classes Application Form

This document is an application form for various test preparation courses offered by VPM Classes. The form requests personal information such as name, date of birth, address, contact details, educational qualifications and details of the entrance exam and subject for which the applicant wants to enroll. It also includes details of payment such as account numbers and instructions for submitting the completed form along with required documents and payment. The applicant must declare that the information provided is accurate and agrees to the terms of registration.

Uploaded by

Prashanth Kumar Reddy
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Registration No.

: (for official use only)

CSIR UGC NET, GATE (ENGINEERING), GATE (Science), IIT-JAM, UGC NET, TIFR, IISc, NIMCET, JEST etc. Address : VPM CLASSES 1-C-8, SFS, Talwandi, Kota (Rajasthan) -324005 Ph. (0744) 2429714, 09001297111 Website: www.vpmclasses.com Email: info@vpmclasses.com

APPLICATION FORM

Please Affix Your Recent Passport Size Photograph

Which type of course you wish to enrol for? Please tick () CORRESPONDENCE COURSE TEST SERIES OTHERS

YEAR: 2012

2013

2014

2015

| (for NET students only):

June

December

EXAM NAME: ___________________________________________ MEDIUM - English Hindi

SUBJECT: _____________________________________________

(Hindi Medium material is available in selected courses only)

PERSONAL INFORMATION (All the fields are compulsory; Please fill only in BLOCK LETTERS): Name of the Candidate: __________________________________________________________ Date of Birth: DD______/MM______/YYYY_________ Correspondence Address: Sex: Male Female

Fathers Name: _____________________________________________________

___________________________________________________________________________________________

____________________________________________________________________________________________________________________ Ph. (Res.) with STD Code: __________________________________ Mobile No. ________________________________

E-mail ID of the student: ______________________________________________________________________________________________

Educational Background: ( Please fill aggregate % Marks)


Exam passed X XII B.Sc/ B.Tech M.Sc /M.Tech Other Name of school/college Board of Education Year of passing % of Marks Rank/Class

Course Fee payment details:


Demand Draft(DD) No./ NEFT No./ Cash Deposit Drawn on Bank Amount DETAILS VPM CLASSES A/C No. RTGS/NEFT IFSC Code Branch Name PNB 4148001800000019 PUNB0414800 PNB, Nagar Nigam Branch, Kota, Raj. HDFC 18462560000284 HDFC0001846 HDFC, Talwandi Branch, Kota, Raj.

Registration procedure: Submit your completely signed application form with colour photograph, Demand Draft (DD) drawn in favour of VPM Classes payable at any bank at KOTA, RAJASTHAN. or Bank Deposit Slip received from the Bank , Qualification Proof (Mark sheet of Post Graduate (PG) or Under Graduate (UG) or College identity Card etc.). Send all the items to the VPM Classes postal address (mentioned in the top left box of this form) OR E-mail the Scanned copies at info@vpmclasses.com /vpmclasses@yahoo.com/ query@vpmclasses.com Note: Fee of any program is not refundable at any stage. 1. 2. DECLARATION I declare that all the information furnished in this Application Form 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 refund of fee. I will provide VPM Classes with the details (Roll Nos. etc) of the entrance exams which I may appear in the future. I shall not withhold this information from VPM Classes, who are entitled to know the results of their efforts to help me get through the exams. VPM Classes reserves the right to use the photograph for publicity if I am successful in the Entrance Exams. All legal disputes are subject to jurisdiction of the Courts / Authorities of Kota, Rajasthan only.

3.

Date:..................................

Signature (Student):..

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