PS-ID: ......................................................

Roll No.: ..................................................

(To be filled by office only)

Affix your recent

passport size
colour photograph
here.

To,
The Manager - DLP Division
Aakash Institute
Aakash Tower, Plot No. 4,
Sector-11, Dwarka,
New Delhi-110075

Admission Form for DLP Courses (Medical)

COURSE APPLIED FOR

Two Years Comprehensive Study Package

(CSP) for AIPMT / AIIMS - 2017

One Year Comprehensive Study Package

(CSP) for AIPMT / AIIMS - 2016
XII studying
XII passed

Two Years Comprehensive Joint Package

(CJP) for AIPMT / AIIMS - 2017

One Year Comprehensive Joint Package

(CJP) for AIPMT / AIIMS - 2016
XII studying
XII passed

Two Years Comprehensive Joint Package

Plus (CJP+) for AIPMT / AIIMS - 2017

One Year Comprehensive Joint Package Plus

(CJP+) for AIPMT / AIIMS - 2016
XII studying
XII passed

Medium of CSP
English

Target AIPMT - 2016

Target AIIMS - 2016

Mode of AIATS
Online (English)

AIATS for AIPMT / AIIMS - 2016

AIATS for AIPMT / AIIMS - 2017

Hindi
Offline (English/Hindi)

Medium of AIATS (Offline only)

English

NTSE (Stage-II) Test Series 2015

Online without Books
Online with Books
Offline (with books)

Hindi

Centre Name & Code for AIATS (if Offline):

Aakash Explorer for AIIMS - 2016

Roll No. for NTSE Stage-I

Qualified Students

Aakash Explorer for AIIMS - 2017

Respected Sir,
I want to take admission in your esteemed Institute for the Distance Learning Program Course in Medical Stream marked ( ) in the box.
I have read the 'Terms & Conditions' of the institute given overleaf and agree to abide by the same. My particulars are given below:
(It is compulsory to fill the form clearly in CAPITAL LETTERS only)

First Name
Last Name

Mothers Name
Occupation of Father / Guardian

Date of Birth*

Male
D

[Please tick

Female

Blood Group

Category
(GEN / OBC / SC / ST / PH)

the relevant box]

Residence Address
(Permanent Address)

Pin Code

(Number with STD Code)

(Number with STD Code)

(Student)

Mobile: (Parents)*

(for SMS)*

Email ID
Correspondence Address
(Please ignore if same as Residence Address)

Pin Code

(Number with STD Code)

(Number with STD Code)

P.T.O.

School / College Name & Address

Student Class category

X appearing

Marks Obtained

% (X Board, Sc. & Maths - Aggregate)

XII appearing

XI appearing

XII passed

% (XII Board, PCB - Aggregate)

Exam Board

[Please tick

the relevant box]

ISC
CBSE
[Please tick

State Board
Other
the relevant box]

(Attach a self-attested Photocopy of Your Original Marksheet)

Eligibility for Scholarship

5%

10%

How did you come to know about Aakash?

15%

Promotions Team

35%

25%

Newspaper

Teachers

Others

the relevant box]

Ex-Aakashians

Friends/Relatives

[Please tick

[Please tick

Website

Radio/TV

the relevant box]

Sincerely,

Date:

(Signature of the Student)*

Place:

FOR OFFICE USE ONLY

Category of Scholarship

Category-A

Category-B

[Please tick

the relevant box]

Cash/Demand Draft No.:

Drawn on:
Office Receipt No.:

Registration No.:
Admission Place:

Branch

Info. Centre

Promotions Executive

Counsellor (Name):

Date:
Receipt Date:
Prov. Receipt No. (if any):

Terms & Conditions

1.

Incomplete Admission Form will be rejected.

2.

It is compulsory to attach self-attested photocopy of mark-sheet of last qualifying Exam.

3.

10.

If at any point of time, the Central Govt. further increases 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 the Govt.

Students once enrolled in DLP courses cannot claim for refund of fee or part of the fee; if he/she
becomes disinterested during the course due to any reason whatsoever.

11.

Students enrolled in Aakash Institutes DLP Course will have to provide photocopy of Admit Card of
Medical Entrance Exams as soon as they receive their admit cards from the examining body.

4.

It is for the student to see whether he/she is eligible for a certain Medical Entrance Examination or
not. The Institute does not hold itself responsible if a student's admission form cannot be forwarded
or is rejected by the examination body on any ground whatsoever. Such a student cannot claim a
refund of the whole or any part of the fee he/she has paid to the Institute.

12.

Aakash Institute reserves the right to make any alteration in its programs / venue / timing without any
prior notice to anybody. The decision of the Director will be final and binding on the students and the
parents.

5.

It is compulsory for a student to attach a recent passport size photograph on the admission form.
The student should also staple three extra photographs with the form. Institute reserves the right to
use the photograph for publicity in case the student secures position/succeeds in Medical
Entrance Exams.

13.

6.

The responsibility of getting admission form forwarded to the examining body is that of the student
himself/herself or that of the Parents / Guardian.

7.

If the Study material / Content provided to the student is lost/misplaced once delivered at his/her
correspondence address, a duplicate set of despatch can be obtained against the payment of ` 800
per despatch, through Demand Draft in favour of Aakash Institute payable at New Delhi.

8.

Any change of address or phone numbers should be notified to the DLP Division without any delay
through a written application / e-mail at dlp@aesl.in. If the despatch is returned due to change of
address or any reason whatsoever, ` 500 will be charged for sending the despatch again.

In case of any dispute or difference between you and Institute regarding the interpretation of these
terms and conditions, non-payment of any claim or any dispute arising out of or in pursuant to these
terms and conditions, the same shall be referred to sole Arbitrator who shall be appointed by
Chairman of M/s Aakash Educational Services Pvt. Ltd. The proceedings shall be conducted at New
Delhi under the provisions of Arbitration & Conciliation Act and the Courts at Delhi only shall have
the jurisdiction over the matter and/or for enforcement as the case may be. If an Arbitrator to whom
the matter is referred refuses to act or for any reason, does not enter the reference or after entering
into the reference proceedings are abandoned or kept in abeyance or not proceeded with, it shall be
lawful for the Chairman of M/s Aakash Educational Services Pvt. Ltd. to appoint another person to
act as an Arbitrator in the manner aforesaid. Such person shall be entitled to proceed with r e f e r e n c e
from the stage at which it was left by his predecessor, if both the parties consent to this effect, failing
which the Arbitrator will be entitled to proceed de novo.

14.

The Examination Centre of any place can be changed as per the requirement/need of the company
without any prior notice to the students / parents.

Fee once paid is not refundable under any circumstances. The fee includes postage/courier
charges and service tax.

15.

If any student fails to receive the study material within 15 days from the date of despatch, kindly
inform the DLP Division telephonically at 011-47623445 /63 or by writing an e-mail at: dlp@aesl.in.

9.

Check List: 1.
2.
3.
4.
5.
6.

Four recent passport size colour Photographs (latest).

Photocopy of self-attested mark-sheet of last qualifying Exam.
DD in favour of Aakash Institute payable at New Delhi.
Centre Code and Centre Name on Admission Form should be properly mentioned for AIATS.
If you are an Ex-Aakashian, attach a photocopy of Identity Card issued by Aakash along with the Admission Form to avail concession.
It is compulsory to attach proof of scholarship along with the Admission Form.

I have read the terms & conditions of AESPL and various policies of the Company as mentioned in the prospectus & promise to abide by the same.

(Signature of the Parent/Guardian)*

* Note : It is mandatory for Student & Parents to sign at the appropriate places failing which admission form will not be processed and will be rejected.

(Signature of the Student)*