GATE 2013 ENROLLMENT FORM

Enrollment for the year

For Official use

Receipt no.: Date Recd. :

2013

City :

PLEASE FILL UP ALL PARTS OF THE FORM VERY CAREFULLY IN BLOCK LETTERS
First Name Name Email ID Middle Name Last Name

: :

Photograph

Alternate Email ID : Mobile No. Landline No. Postal Address

: : :

Alternate Mobile No. Date of Birth

Please paste your recent passport photograph here

____________ ____________

I agree with terms and conditions on the reverse

City: ____________ Fathers Contact No.

(or Alternate Number)

PIN: Signature of Candidate

Fathers Name

ACADEMIC BACKGROUND
Highest Qualification (Tick the correct option): Currently: Working at BE/B.Tech ME/M.Tech MCA Studying M.Sc. Other (Specify)

____________

Graduated but not working

Year of passing out of graduation

Name of Graduating College Previous Attempt at GATE: Year

City of Graduating College Stream Score

Rank

Not Applicable

GATEFORUM Reached You Through:

Newspapers Ads________________________ College Posters eTutor Demo DVD CH BT

SMS

Leaflets Website

Seminars

Banners

Online Ads

Google Search

Others__________________________ Classroom Postal

ENROLLMENT DETAILS
Stream: EC CS ME
ICP Plus

eTutor Mode:
EE IN CE

Mode of Test Series:

FOR OFFICE USE

DLP Plus

GATE PACKAGES :

Intensive Classroom Program (ICP) TarGATE Plus Others

Classroom Coaching Venue Batch ID Test Series Venue Roll number generated online:

Distance Learning Program (DLP) Online Test Series (OT)

* Package Acronyms explained on reverse

All India Test Series (TarGATE)

(Other Package Name)

eGATE

NON GATE PACKAGES :

PSU CRT

GPAT 2012

UPGRADES/INSTALLMENTS
Name of the PSU

Upgraded to:
Others

On:

PAYMENT MODE
Cash Cheque DD COMMENTS Card Online Transfer Others
____________

AMOUNT PAID
**

Rs.
Upgrade/Installment Receipt No.

Instrument of Bank and Branch: ____________ Instrument Number: ____________ Instrument Date:

____________
** **

Books Issued
____________

LOGISTICS On D D

Courier Name & No.

____________ ____________

Logistics Comments

CHECK LIST
To Enroll Please Send/Submit the Following : 1. Completely Filled up Application Form 2. Two photographs attached to the Enrollment Form, as specified. 3. DD/Cheque # (should be) in favour of Gateforum Educational Services (P) Ltd, payable at Hyderabad. For online transfer please refer website or download updated enrollment form from www.gateforum.com. Send Transaction Record Printout in case of Online Transfer. Send Original Receipt in case of Cash Deposit at any ICICI Bank branch in India. Account Details: A/c. No: 018305006169 IFSC Code: ICIC0000183 ICICI Bank Ltd., Begumpet Branch, Hyderabad. ** Instrument may be Cheque/ DD/ Credit Card, Account Number, etc.,

Photograph
Please Staple one Passport-size photograph here. Write the Name and City on the reverse side of your photo.

INCOMPLETELY FILLED UP FORMS WILL BE SUMMARILY REJECTED.

Terms and Conditions

1. GATE Packages :
l l

eGATE - Live Classes. Fees - Rs. 15,000.

ICP - Intensive Classroom Program - Classroom Coaching + Correspondence Course (CC) + All India Test Series (TG) + Online Test Series (OT).

ICP Plus - Classroom Coaching + eTutor + Correspondence Course (CC) + All India Test Series (TG) + Online Test Series (OT). DLP - Distance Learning Program - Correspondence Course (CC) + All India Test Series (TG). Fees - Rs. 8,000. DLP Plus - Correspondence Course (CC) + eTutor + All India Test Series (TG) + Online Test Series (OT). Fees - Rs. 11,000.

l l l l l

TarGATE (TG) - All India Test series (TG). Fees - Rs. 3,500.

TarGATE Plus (TG Plus) - All India Test Series (TG) + Online Test Series (OT). Fees - Rs. 4,500.

Online Test Series - Online Test (OT). Fees - Rs. 1500.

2. Fees once paid will not be refunded under any circumstance. After paying the fees, even if a student is eligible for any discount, the amount paid will not be refunded. 3. GESPL reserves the right to announce and withdraw discount schemes at its own discretion and no claim of any kind will be entertained in this matter. 4. In case a student goes for upgrade/change of packages/change of center/change of city, etc. an extra amount will be charged as per company policy apart from normal fees for the packages. 5. GESPL reserves the right to change the schedule and timings of classes and tests at its own discretion. 6. While utmost care is taken to provide correct and up to date information, GESPL does not guarantee the accuracy, completeness and timely availability of the information provided and accepts no responsibility or liability for any error or omission in any information provided. 7. In case of reprint of study material during the academic year, due to lack of stocks or a revision of content, GESPL does not take the responsibility to distribute the reprinted edition to the students who were admitted earlier. 8. GESPL reserves the right to change the date of issue of study material and will not be liable for any delays in the material or test papers reaching a student. 9. GESPL reserves the right to cancel a center and transfer the center students to another center in the same city, in case of ICP. GESPL also reserves the right to convert the mode of a student from Classroom to Postal under extraordinary circumstances of having to close down a center. 10. The study material, CD, test material etc. are exclusive copyright of GESPL, and cannot be reproduced in print or otherwise, without explicit permission of GESPL. 11. The student has gone through the terms and conditions. By enrolling, a student agrees to abide by the rules and regulations and company policies of GESPL as specified on this page, and on the website at: Detailed terms and conditions can be found at our website : http://www.gateforum.com/termsconditions.php For all purposes, Gateforum Educational Services Private Limited is referred to as GESPL above.
I understand the terms and conditions and I agree to abide by the terms and conditions of Gateforum.

Name : _______________________________________ ________________________ Signature