Professional Documents
Culture Documents
Please Note :
v Check the availability of the program at your preferred FIITJEE centre before making a choice. v Make a photocopy of this form after filling the required information and before submitting it to FIITJEE. v Log on to www.fiitjee.com/regupdate.htm to update your Contact Details online using Registration Number and web access code printed on your Hall Ticket.
Enrolment Form
Registration Number (as mentioned on the Hall Ticket) :_______________________________________________ Study Centre Program Name (refer page no. 13 & 14) Program Code (refer page no. 13 & 14) Scholarship Awarded % (if applicable) : _________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin : _________________________________ Contact No (Mobile) Permanent Address (if any) : ____________________________ Land Line (with STD Code) : ___________________________________ : _______________________________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ _________________________________________________________________________________ Pin :_________________________________ Contact No. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________
Business
: ________________________________________________ Qualification : _________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________
: ________________________________________________ Qualification : _________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________
Enrolment Form
(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler)
Local Guardians Name Occupation : Business : ________________________________________________ Qualification : ________________________ Govt. Service Pvt. Service Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________ Nature of Business / Job Department Office / Business Address : ____________________________ Designation : _____________________________________________ : ____________________________ Contact No (office) : _________________________________________ : _______________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________ E-Mail ID Mailing Address : ________________________________________________ Mobile No : ___________________________ : _______________________________________________________________________________________
(if applicable)
Fee Details :
II
III
: _______________________________________
Instrument Number
Dated
Enrolment Form
Affix one self attested passport sized photograph of the person issuing Post Dated Cheque(s) i.e. parents / guardian
Cheque No.
Dated
Issuing Bank
Fee Amount
S. Tax Amount
Total Amount
I further agree to get above Post Dated Cheque(s) cleared, even if, my son / daughter / ward discontinues studies at FIITJEE, irrespective of any reasons. I am signing the above declaration in good mental / physical health. I have satisfied myself about FIITJEE. The necessary Enrolment-Forms, including this form was received by me several days before the actual date of signing to enable me to understand the implications of taking admission at FIITJEE. I have taken expert opinion regarding matters which were not clear to me and I am satisfied.
Father / Mother / Legal Guardians Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________
Date : _____________________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE. Date : _________________________________ Place : _________________________________
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Enrolment Form
Father / Mother / Legal Guardians Signature {Who has issued the cheque(s)} Name : ______________________________________ Address : ____________________________________
_____________________________________________
Date : _____________________________________________________
_____________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Enrolment Form
4. How would you rate the student in the following characteristics ? ( the appropriate)
Excellent Sincerity Leadership Imagination Emotional stability Ability to work with others Ability to work hard Perseverance Good Average Below Average Low Unknown
6. What is the students class rank? : ____________________________________________________________________________ 7. Some gifted individuals make mediocre scholastic records. Is the students record an accurate index of his/her capabilities? Yes / No If no, state why? : ______________________________________________________________________________
8. What is the students biggest weakness? : ______________________________________________________________________ 9. Have there been any major changes in the students attitude towards studies till now at any time, if so illustrate, when and why?
(You may attach a blank page if required.)
10. Please mention any other information relating to the student, which help make FIITJEE understand the student better. ________________________________________________________________________________________________________ ________________________________________________________________________________________________________
11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health to successfully cope up & complete his/her studies at FIITJEE and fulfill all terms & conditions.
Enrolment Form
Annexure D
Kindly do not take admission at FIITJEE if the clauses of the declaration on the Enrolment Form on page no. 10 & 11 is not agreeable to you. Name of the Student : _________________________________________________________________________________________ Name of the Father / Parent / Guardian: ___________________________________________________________________________ Residential address : ___________________________________________________________________________________________ Specific Declarations (10 & 22) are being reproduced hereunder : Declaration 10 : In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be, neither is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. Declaration 22 : I/We, the parent / guardian and/or the student, hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form, Annexure and Declarations and agree to abide by them without any reservation or ambiguity. I/We further declare that the above named student is taking admission in the ____________________________________________ ___________________________________________________(course opted for) having considered everything material and on his/her own sweet will and with the permission of the Father / Mother / Legal Guardian without any coercion from any side.
Name : ____________________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Date : _______________________________
Place : _____________________________
Instruction : After filling-up annexure A, B, C & D please retain photocopy of the same before submitting at the FIITJEE
Checklist :
1. Demand Draft(s) / Pay Order(s) for the fee 2. Local / at par post dated cheque(s) 3. Enrolment Form duly filled in 4. Annexure A to D 5. Colour Photographs: (a) Passport size (Six) (b) Stamp size 2.5 x 2 cm. (One)
6. Admission Test / FTRE / FTSE / Fortunate - 40 Hall Ticket (in Original) 7. Admission offer letter (in Original) 8. Any one of the following documents : (a) Photocopy of School ID card with photograph or (b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student or (c) Photocopy of Transfer Certificate or (d) Bonafide certificate issued by the Principal of School with students photograph
Enrolment Form
Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________
Enrolment Form
DECLARATIONS / UNDERTAKINGS
Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you
4.
5.
6. 7.
8.
9.
10. In addition to the above, I understand without any ambiguity that the fee once paid is not refundable at all, whatever the reasons be, nor is it adjustable towards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student. 11. I undertake that I shall abide by the rules & regulations of FIITJEE or FIITJEEs associated schools. I undertake that in case of any dispute relating to breach / violation of any of the Rules & Regulations of FIITJEE or FIITJEEs associated school, the decision of the Management of FIITJEE shall be final and binding in all circumstances and situations, whatsoever. 12. It is understood that this admission is valid only for the course and the duration for which I am taking admission and I/We (the student and the Parents / Legal Guardian) shall not claim / request for admission to and adjusting the fees to any other course or duration. 13. I/We acknowledge that the course materials provided to the student by FIITJEE during the course of study at FIITJEE are the intellectual property of FIITJEE and solely for personal purposes and not for commercial use. I further undertake that I shall not make copies of the study material provided by FIITJEE nor shall provide / give / distribute it to anyone else. 14. FIITJEE has enjoyed great relationship with the students and parents. Almost all students in every class and every program have been succeeding in coping up with huge pressure of simultaneous preparation for competitive exams along with school / board studies. In few cases where some students do discontinue because they are not able to cope up with simultaneous competitive exam preparations along with school / board studies, the parents have continued to support the good work of FIITJEE. What will constitute deficiency in service? If the average feedback of the particular subject teacher goes below 70% in the Feedback Form Annexure - FB (attached herewith), then the said teacher will be considered to teach below the minimum FIITJEE Standard. If a teacher gets less than 70% feedback in two consecutive periods then his/her teaching will be considered unsatisfactory by high FIITJEE standards.
15. I/We have fully satisfied ourselves with regards to quality and excellence of teaching at FIITJEE from all available information / sources and have decided to study only at FIITJEE. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option (the same is signed by me & the student and is attached with this enrolment form) at our own sweet will and convenience without any pressure / coercion from any one. 16. I/We agree to submit a photocopy of the JEE Admit Card of the student by 25th March of the concerned JEE year to FIITJEE and admit card of various Other Engineering Entrance Exam as soon as I/We receive the same from the examining body.
Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________
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Enrolment Form
DECLARATIONS / UNDERTAKINGS
17. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word of mouth among the students. I/We undertake that I / we shall / will fully cooperate to achieve this objective including giving the JEE Admit Card before 25th March of the concerned JEE year and signing the letter of appreciation lauding FIITJEE efforts. I/We further undertake that I/We shall attend the seminars / workshops / felicitation / interview etc. conducted by FIITJEE after achieving rank by the student; however FIITJEE shall alone bear the entire cost and expenses in respect thereof. I further undertake to endorse the efforts and contributions made by FIITJEE In achieving the rank while giving Interviews to the media (print / electronic / web). If we fail to give the JEE admit card by 25th March of the concerned JEE year, FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student / parents / legal guardian will have no objection to the same. 18. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further agree to give a letter of appreciation to FIITJEE for the outstanding result in form of a Letter, a Video Interview or any other forum / format that FIITJEE deems fit. 19. I/We undertake and acknowledge that incase I/We indulge in any kind of litigation with FIITJEE, I/We shall not be entitled for any Awards / Rewards / Scholarships / Benefits etc. from FIITJEE and shall refund / return such Awards / Rewards / Scholarships / Benefits etc. If availed by the student, within a period of 15 days, failing which FIITJEE shall be entitled to recover the same through the appropriate court / forum alongwith interest, damages and cost of litigation. 20. I/We undertake that I (student) shall not indulge in any illegal / unethical / unprincipled / immoral / corrupt / dishonest activities which may cause loss of property, reputation and goodwill of FIITJEE. I/We further undertake that I/We shall compensate for/ indemnify against any loss /damage caused to FIITJEE. 21. If a student is awarded scholarship by FIITJEE and does not perform at a similar level after joining FIITJEE Classroom / Integrated School Program then a probe may be lodged to find out if the student got scholarship on his / her own merit or by using any unfair means. Parents and Guardians of the student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and also a compensation of Rs. 10 Lacs, if the investigating committee concludes that student had not secured the scholarship on his / her own merits. Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.
22. I/We, the parent / guardian and/or the student, hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained in this Enrolment form, Annexure and Declarations and agree to abide by them without any reservation or ambiguity. 23. I/We further declare that the student named on page no. 3 is taking admission in the program as mentioned on page 3 having considered everything material, on his/her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission of the Father / Mother / Legal Guardian without any coercion from any side. Further I/We understand that the student is required to work hard to attain the average standard of the batch allotted in order to cope up with studies and put in extra efforts if lagging behind in any subject / topic. 24. I/We further undertake to ensure that cheques / drafts including post dated cheques if any given by us will be honoured by our bankers. In the event of these cheques/drafts being dishonoured, FIITJEE is at liberty to initiate any action against us including legal proceedings under section 138 of Negotiable Instruments Act or other appropriate law. 25. I know that registered office of FIITJEE Ltd. is situated at New Delhi. 26. I promise to abide by all rules and regulations of FIITJEE declaration, in letter and spirit. 27. In the event of any dispute between the parties regarding the interpretation of clauses of enrolment form or any claim etc. arising out of taking admission in FIITJEE, the matter shall be referred to the Sole Arbitrator appointed by FIITJEE Ltd. The arbitration proceedings shall be conducted in accordance with the provisions of the Arbitration & Conciliation Act, 1996 and statutory modification thereof & rules made thereunder. It is further agreed that in spite of the fact that the Sole Arbitrator may be known to any of the Directors or share holders and that he may have been dealing with the Company or had occasion to deal with any matter of this agreement shall not disqualify him. Even if the Arbitrator may have expressed opinion in similar matter earlier shall also not render him disqualified. The arbitrator so appointed shall not be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or Group / Subsidiary Companies, and for reasons of having any prior linkage with the company. The decision of the arbitrator shall be final & binding on both parties. The venue of Arbitration shall be Delhi / New Delhi only. 28. Subject to clause 27 above, I/We (the student and the Father / Mother / Legal Guardian) understand that in case of any legal dispute, the jurisdiction will be an appropriate court/forum in Delhi / New Delhi only and I/We shall not take recourse to such an action in any other court / forum or anywhere else. In case I do, I shall inform the relevant court / forum regarding this jurisdiction constraint. 29. I have read the above carefully and have understood it clearly. I/We have also read the current FIITJEE Brochure carefully and have understood it clearly. I have kept a photocopy of all the pages of this enrolment form including this declaration and Annexures A, B, C & D for my future reference and timely compliance.
Signature of Father / Mother / Legal Guardian Name : _________________________________ Date : __________________________________ Place : __________________________________
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Enrolment Form
DECLARATIONS / UNDERTAKINGS
(Declaration to be given by the student if Father / Mother / Legal Guardian does not reside in the Study Centre City, neither does he/she have any Local Guardian) As my Father / Mother / Legal Guardian do(es) not reside at _______________________________________ and I have no Local Guardian. I own all responsibility on their / his / her behalf.
(Declaration to be given if the Enrolment form is not signed by the Father / Mother / Legal Guardian at the time of admission) I have received an extra copy of this Enrolment Form, which I shall send to my Father / Mother / Legal Guardian and submit to FIITJEE within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities in writing, my admission shall be liable to be cancelled and I or my Father / Mother / Legal Guardian shall have no claim for refund of fees or any other compensation of any type.
For Office use only Check list for the Accountant / Admission Coordinator.
v v v
Name of the Accountant / Admission Coordinator : _____________________________________________________________ The Application form is complete in all respect with Annexure A, B, C and D duly signed by the student and the parent. The details of the scholarship offered. o Cash scholarship (If any) : _______________________________________________________________________________ o Fee Waivers offered (If any) : ___________ % on ____________________________________________________ ground o Hostel fee waiver (If any) : ______________________________________________________________________________ The certificates pertaining to scholarship are attached. 6 passport size and one stamp size photograph are attached. Late payment charges / Admin. charges duly calculated and collected. The fee charged has been duly matched and verified with the fee brochure. Signatures on PDCs and on Annexure B and C are same. Is the student joining as a Hosteler? If yes details of the Local Guardian are provided. The student has been offered the admission after selection in Admission test only.
v v v v v v v
Declaration by the Accoutant / Admission Coordinator. I have verified the entire Enrolment form and checked all the points mentioned above. The Enrolment is recommended.
Date : _______________________
Place : _________________________
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Enrolment Form
Program Code
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Enrolment Form
Program Code
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Delhi (South) Delhi (Punjabi Bagh) Delhi (East) Noida (Delhi-NCR) Gurgaon (Delhi-NCR) Chandigarh Lucknow Jaipur Gwalior Bhopal Vadodara Indore Nagpur Mumbai (Kandivali) Mumbai (Chembur) Pune Bokaro Bhilai Raipur FIITJEE Junior College Visakhapatnam FIITJEE Junior College Vijayawada Chennai (Adyar) Chennai (Kilpauk) Chennai (Sriperumbudur) Chennai (KK Nagar)
Andaman and Nicobar
Bhubaneswar Ranchi
Kochi Coimbatore
Bangalore
Lakshadweep (India)
Delhi (South) Chandigarh Delhi (Punjabi Bagh) Delhi (East) Meerut Amritsar Lucknow (Gomti Nagar) Lucknow (Aashiana) Gorakhpur
Delhi (Rohini) Delhi (Janakpuri) Delhi (Dwarka) Noida (Delhi-NCR) Gurgaon (Delhi-NCR) Faridabad (Delhi-NCR) Ghaziabad (Delhi-NCR)
Kanpur Allahabad
Bhopal
Varanasi Patna Dhanbad Bokaro Kolkata (Rabindra Sadan) Kolkata (Ultadanga-Salt Lake) Durgapur Ranchi (Lalpur) Ranchi (SOP Doranda) Raipur Bhilai Shaktinagar NTPC
Andaman and Nicobar
Mumbai (Dadar) Mumbai (Chembur) Mumbai (Kandivali) Mumbai (Andheri) Mumbai (Navi Mumbai) Mumbai (Thane) Pune Hyderabad (Saifabad) Hyderabad (Dilshukhnagar) Hyderabad (Kukatpally) Bangalore Kochi
Lakshadweep (India)
Bhubaneswar
Visakhapatnam Vijayawada Chennai (Nungambakkam) Chennai (Kilpauk) Chennai (Adyar) Chennai (Sriperumbudur) Chennai (KK Nagar)
Coimbatore
National Admissions Office : FIITJEE House, 29-A, Kalu Sarai, Sarvapriya Vihar, New Delhi - 110 016 Ph. : 011 - 46106000 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax : 011 - 26513942 Web : www.fiitjee.com