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ENROLMENT FORM

Correspondence Programs

Enrolment No. :
(For official use only)

(To be filled by the student)


Please Affix Your
Recent Passport Size
Colour Photograph

Name of Program Enrolling for :


(for list of Programs see page no. 4)

Preference of Test Centre


for AITS for JEE (Main & Advanced) :
(for list of Test Centres see page no. 3)

Name of the Student

Fathers/Guardians Name :
Mothers Name

Date of Birth

Nationality :

Correspondence Address :

Pin :
Ph. (Res.) with STD Code :
Permanent Address

Mobile No. ** :

Pin :
Ph. (Res.) with STD Code :

Mobile No. :

School affiliated to

CBSE

Class

IX

Science+Math/PCM (%) :

X Board

Marks (if in Grades)

X Board- Science

Category of Student

General

ICSE

Other (Please Specify) _____________________________

X
.

XI
%

XII
XII Board

XII (Pass)
.

Maths

XII Board- P

Other (Please specify) ____________________________

E-mail ID of the Student :


(in Block Letters)

** Please mention if you want to receive information through SMS on this mobile:

Yes

No

FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
All India Toll Free No. 1800 11 4242, E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com
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Nearest relative / Guardian Address (to be contacted in case the student is not available at the above mentioned address):

Pin :
Ph. (Res.) with STD Code :

Name of the School

Mobile No. :

(studying or passed)

Name of the Principal

School Address

Pin :
Phone No.:

Details about your Parents:

Particulars

Father

Mother

Name
Qualification
Occupation
Designation
Company Name
Company / Office Address

Company / Office Tel. No.


Mobile No.
E-mail (in Block Letters)
Annual Income

FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
All India Toll Free No. 1800 11 4242, E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com
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Test Centres$ for All India Test Series (AITS) for JEE (Main & Advanced) (only one centre can be opted):
Delhi (South), Delhi (North-West), Delhi (East), Delhi (Dwarka), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Delhi NCR (Gurgaon),
Delhi NCR (Noida), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai,
Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dehradun, Dhanbad, Durgapur, Gaya, Gorakhpur, Guwahati, Gwalior, Hisar,
Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota,
Lucknow, Ludhiana, Meerut, Mumbai (Andheri), Mumbai (Chembur), Mumbai (Kandivali), Mumbai (Navi Mumbai), Mumbai
(Thane), Muzaffarpur, Mysore, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee, Rourkela, Shaktinagar NTPC, Siliguri,
Thiruvananthapuram, Thrissur, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Visakhapatnam.
$ Above are the Test Centres for All India Test Series for JEE (Main & Advanced) only.

Note: All India Test Series (One Year & Two Year) is also available by Correspondence
(All the Test Papers to be received & attempted at your home.)

Course Fee payment details :


Demand Draft No.

Drawn on Bank

Dated

Check List (Please tick in the box):


1. Photocopy of
X / XII Board Marksheet*
VIII school final exam marksheet* (for Junior Rankers Study Material)
2. Colour Photographs (4 Passport Size)
3. Demand Draft for Course Fee

Amount

* In case of claim for scholarship, marksheet / certificate of Scholastic Achievement is to be attested by the past or present School Principal.

Note 1:
Note 2:
Note 3:
Note 4:
Note 5:

Fee of any program is not refundable at any stage.


All India Test Series is part of Rankers Study Material. You need not enrol for it separately in case you are enrolling yourself for Rankers Study Material.
Please write your name behind your Photograph and your name & address behind the Demand Draft.
The Demand Draft for course fee for all the above mentioned JEE programs should be in favour of "FIITJEE Limited - TS, RTPF, GMP A/c" payable at
New Delhi.
Photocopy of this form can also be used.

Place: ______________
Date: ______________

(Signature of the Student)

(Signature of Parent / Guardian)


Name _______________________________________________
Relationship with the Student____________________________
Mobile. No. of Parent / Guardian _________________________

FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
All India Toll Free No. 1800 11 4242, E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com
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For JEE (Main & Advanced), 2015 (for Class XII & XII Pass)
I am interested in enrolling for (Tick the appropriate box)

Last date to receive completed application

Open Test

7th February, 2015

Grand Masters Package

Available from November, 2014

Rankers Test Papers File

Available from December, 2014

For JEE (Main & Advanced), 2016 (for Class XII & XII Pass)
I am interested in enrolling for (Tick the appropriate box)

Last date to receive completed application

Rankers Study Material (One Year Version)

31st August, 2015

One Year All India Test Series

8th November, 2015

One Year All India Test Series (By Correspondence)

15th November, 2015

For JEE (Main & Advanced), 2017 (for Class XI)


I am interested in enrolling for (Tick the appropriate box)

Last date to receive completed application

Rankers Study Material (Two Year Version)

20th September, 2015

Two Year Integrated All India Test Series

29th November, 2015

Two Year Integrated All India Test Series (By Correspondence)

6th December, 2015

For Students of Class X (for Target NTSE, 2015 - 16)


I am interested in enrolling for (Tick the appropriate box)

Last date to receive completed application

FIITJEE All India Open Test Series for Target NTSE 2015 - 16

30th June, 2015

Single Test of Target NTSE Test Series (Please mention Test Date)

One week before Test Date

For Students of Class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad
& Foundation JEE (Main & Advanced) / KVPY / NTSE / Other Competitive Exams
I am interested in enrolling for (Tick the appropriate box)

20th September, 2015

19112014

Jr. Rankers Study Material

Last date to receive completed application

FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110 016, Ph: 011- 46106068 / 64 / 10 / 13 / 15
All India Toll Free No. 1800 11 4242, E-mail: query.dispatch@fiitjee.com, website: www.fiitjee.com
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