Application Form No.

Are you already Enrolled / Registered in APEX ? If yes, please provide the following info below:

Students ID Mobile Number

1. Details about the Student:

a) First Name Middle Name/Initials Surname

b) e

c) f

d)

Non-Engineering: Humanities Fundamental Science Commerce Medical If other, please specify

Other Details:

b Category Gen BC SC ST

(d) How do you want to receive the Hall Ticket E-Mail Printed
(Printed Hall Tickets will be issued only if this Application Form is submitted to a APEX office in person.)

(a) E-Mail IDs and Mobile Nos.

E-Mail ID (Please Fill in BLOCK Letters Only) Mobile Number

Student

Father

Mother

What is your preferred e-mail ID Student Father Mother What is your preferred Mobile No. Student Father Mother

(b) Correspondence Address: (c) Permanent Address: (Please mention only if different from
Correspondence Address)
(Please do not write your / your Father’s name in these address boxes. Fill the address only within the space provided in boxes.)

Pin Pin
5. Details about Parents (in BLOCK Letters only)

Father's / Legal Guardian Name …………………………………………………………..………..

Qualification Occupation . Designation

Office Name / Address

Contact Nos

Mother's Name …………………………………………………………..………..

Qualification Occupation . Designation

Office Name / Address

Contact Nos

6.

NTSE JSTSE NSEJS KVPY Olympiads SAT Reasoning SAT Subject Test TOEFL Others

8.

9. How did you come to know about APEX Programs ?

Newspaper Advt. Social Media News Paper Insert Banner / Poster Website E- Mailer

Hoardings Present / Ex- APEX Student Friends / Relatives Through APEX Faculty if other source (please specify)

(1) I / we have received & read the Terms & Conditions printed in this Application Form and promise to abide by the same.

(2) Registration Fee will not be refunded in any case of transferred to any other Admission Test Date.

(3) I authorize APEX to contact and send communication / information by SMS, e-mail, post on the above mentioned communication details given by me.

(4) In case a student reappears in APEX Test, his / her scholarship (if awarded) will be scaled down by one slab so that he / she does not have any undue advantage

over fresh appearing students.

(5) Once a student joins the study centre offered (irrespective of his / her choice of study centre opted before joining), no request for change of study centre will be

entertained, nor the course fee paid will be refunded under any circumstances.

/ Cheque No

Head Office: 62, Nitikhand-III, Indirapuram,Ghaziabad Branch Office: C-27, R.D.C. Rajnagar,Ghaziabad
Ph.:0120-4331180 Mobile.: +91-9990495952, +91-9910817866 Ph.:0120-4331180 Mobile.: +91-9990494712, +91-9310122993
Web: www.apexiit.co.in/ Web: www.apexiit.co.in/