ADMISSION FORM

For office use only.

Roll No.
Receipt No.
Date.
Remarks.
Affix Passport
Size Photograph
here
I wish to enrol in your GATE course. I herewith remit Rs. in favour of Elite Academy, Mumbai
in the following way.
1. Name in full : Mr. / Mrs. / Miss.
(In Block Letters)
2. Parent's / Guardian's Name : Mr. / Mrs.
3. Address :
PIN
4. Contact Telephone - Res No: Cell No : Office No :
5. Date of Birth 6. Parent's/Guardian's Profession :
7. Name and full postal address
to which course material is to be
despatched. (In Block Letters) PIN
8. Educational Qualifications : Subject/Branch
9. E-Mail :
10. College in which you are
studying now/last attended.
11. Name of Employer
84, Janmabhoomi Marg, 2nd Floor, Fort, Mumbai - 400001.
Tel : 022- 66331313, 022 - 22837771
ELITE - GATE 2015
BANK DETAILS :(For Online Payment only )
Account Name : ELITE ACADEMY
Account No. : 67092058762
IFSC Code for NEFT/RTGS : SBTR0000001
Bank Name : State Bank of Travancore,
Mumbai Main Branch,
Mumbai - 400023.
PAYMENT DETAILS :
M.O./Chq/DD No. :
M.O./Chq/DD Date :
Online Transaction ID :
Bank Name :
Bank Branch :
CASH
M.O.
DD/Chq
Online Bank transfer
}
Note :
1. At par Cheques / Cheques or DD drawn on
any Bank, payable at Mumbai in favour of
Elite Academy will be accepted.
2. In case of online transfer / cash deposit for online
transfer at any bank branches having core
banking facility, kindly send your Transaction
Record printout.
Bank charges are to be paid by the student.
P.T.O.
12.I wish to join for the following subject/subjects in ELITE-GATE. ( Mark the appropriate box about
choice of your subject)
I hereby declare that the above details are true to the best of my knowledge and belief and that I
have read the prospectus thoroughly and agree to abide by the rules and regulations therein.
Place :
Date :
P. S. 1. Payment in cash will be accepted only across the counter.
2. Subject to Mumbai J urisdiction.
1. Biotechnology
2. Chemical Engineering
3. Civil Engineering
4. Computer Science & Information Tech.
5. Electrical Engineering
6. Electronics & Communication Engg.
7. Instrumentation Engineering
8. Mechanical Engineering
9. Metallurgical Engineering
Signature of the Student
*Strike out whichever is not applicable.
10. Production & Industrial Engg.
11. Chemistry
12. Mathematics
13 Physics
14. XE/XL*
(subjects)
1.
2.
3.
4.
5.
Course with QB Only Course with Only QB with
& Test Series & GA GA & Test Series Test Series & GA
( MARK THE APPROPRIATE BOX)
(Specify the name of the Newspaper) (Specify the name of the Newspaper) (Specify the name of the Newspaper) (Specify the name of the Newspaper) (Specify the name of the Newspaper)
NOTE :
I came to know about Elite Academy from :
Newspaper Magazine
Internet Other Sources
(Specify the name of the Magazine)
(Specify the Website) (Specify the Details)