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1/23/12 Vibrant Academ(I) Pt. Ltd.

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Regiaion Fom

For Office use onl
Vibrant Roll No.
If Pa b DD then Attach DD of Rs. 1000 /- in favour of Vibrant Academ India Pvt. Ltd.
Paable at Kota (Raj.). Write UId, Candidate Name, Address and Mobile no at the back of DD
UId 52145 Coe Name : Mico Phae I
Te Cene (1 Choice) Koa 2. Koa
Dae Of Bih 05 Sep 96 Gende : Male
Sden Name VISHWESH RAVI SHRIMALI
Fahe Name ASHISH RAVI SHARMA
Fahe Occpaion Go Seice
Deignaion AEN
Dep. STPS , RRVUNL , SURATGARH
Pemanen Adde R-3/89, STPS COLONY , SURATGARH , DISTT. SRIGANGANAGAR , SURATGARH
Cit SURATGARH State Rajashthan-335804
Email vishweshshrimali5@gmail.com Phone
Mobile(Student) 9414345430 Mobile(Father) 9413349598
Last Class X NTSE II Stage. Yes
NTSE Stage * Final Categor Gen
* NTSE second stage qualified. Please Attach proof
Cla School Yea Boad Mah Sci PCM Agg
IX
KENDRIYA VIDYALAYA STPS
SURATGARH
2011 CBSE 95% 95% NA 95%
X NA
XI NA NA
XII NA NA
Mention the performance of previous competitive examination, if Any




if pa b DD then DD Details
DD No. : ____________________________________ Bank Name : _______________________________________________
DD Amount : ________________________________ DD Date : __________________________________________________
If Pa Online then write Receipt No.
Receipt No. : ___________________________________
Signature{Applicant) with Date Signature{FatherJGuardian) with Date
Paste latest
Passport Sie
Colour Photograph
1/23/12 Vibrant Academ(I) Pt. Ltd.
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Refund Rules General Rules
A. On Application For Selection Test :
Application Form Fee of Rs.1000/- is not refundable under any circumstance
whether you appear for selection test or not. Those sending the Demand Darft for
obtaining Application Form will write their complete and clear postal address with
PIN Code to avoid the postal delay.
Students will ensure to appear for the selection test on the centre mentioned on
Application Form. If student does not appear for the selection test for any reason
the application form fee will not be refunded. For any discrepancy before selection
test date student will call up our office for clarification.
B. On Joining our Course :
In case you do not join our course after your selection for any reason or
discontinue our course due to some reason or the other, fee will be refunded on
submission of application in prescribed form , duly filled ,in the office .No request
on Mail, Fax, SMS telephone or any other mode will be entertained. Refund will be
made as per following:-
From the date of commencement of course i.e.
Micro Course 30.4.2012
Mega Course 04.4.2012
Nano Course 04.6.2012
Googol Phase 1 23.4.2012
Googol Phase 2 25.6.2012
Refund will be given as following
Within a week 85% of Ist installment of basic fee
From Ist week to 2nd week 75% of Ist installment of basic fee
From 2nd week to 4th week 50% of Ist installment of basic fee
From 5th week to 6th week 25% of Ist installment of basic fee
From 7th week to 8th week 10% of Ist installment of basic fee
And no refund thereafter
No refund is allowed out of 2nd installment of fee amount.
Amount paid by you as taxes will not be refunded
Date of fee refund is universal even if you join late or do not attend even a single
class.
The fee refund will be made in form of Account Payee cheque only in favour of the
students father (in case father is not alive then it shall be made in the name of
mother or in case if both are not alive then it shall be made in the name of
guardian in blood relation)
The fee refund cheque will be sent by registered post /courier at his/her permanent
address or the address given by him/her in the refund application
In case a student is involved in an incident of indiscipline at any point of time and
rusticated by the institute, no refund of fee will be applicable in such a case.
Any legal mater/dispute related to fee refund is subject of Kota City( Rajasthan)
Jurisdiction only.

*
Mention your Correct E-mail Address, while
filling application form.
*
Please keep visiting our web site at regular
intervals to keep yourself updated with
the current happenings & your academic
performance.
*
Student will attend their classes in their own
batches; non compliance of this will result into
suspension for one week and loss of studies will
not be compensated.
*
Incase you dont receive the admit card by post,
you can download the same from our website
4 days prior to the test date.
*
If the student indulges in any kind of unfair or
unsocial activity, it is the responsibility of the
students and his parent only. The institute bears
no responsibility for the same.
*
Commutation to institute will be the sole
responsibility of the student. If any mishap
occurs during travelling to the institute it is
solely the responsibility of the student.
*
Medium of instruction is English only and all
literature provided by us is solely in English.
*
Signature of applicant and father / guardian
on both sides of application form is must,
otherwise form will be rejected.
*
Students found using mobile inside the campus
will be fined as : First Time Rs. 200/-, Second
Time Rs 300/-, Third Time Rs. 1000/- and after
that Mobile will be forfeited.
*
Please save your time by checking your
application status on our website. Getting a
telephonic reply in this regard may be time
consuming due to rush on telephone line.
* Loss of I-card will incur a fine of Rs. 200/-
*
In case any student is found seeking admission
by fraudulent means he / she will be removed
from the rolls of the Institute immediately and
no refund of fee/caution money etc will be made
under any circumstances.
*
We reserve the right to delete any course and
deny for admission without assigning any
reason.
Declaration: I have read above rules and agree to abide b them.


Signature(Applicant)
with date
Signature(Father/Guardian)
with date
1/23/12 Vibrant Academ(I) Pt. Ltd.
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ADMIT CARD
Reg N . :
Coe Applied Fo
Mico Phae I
Affi lae
Papo Sie
Colo Phoogaph

Name
[In Block Lee]
V I S H W E S H R A V I S H R I M A L I
[A in applicaion fom]
Fahe' Name
[In Block Lee]
A S H I S H R A V I S H A R M A

FOR OFFICE USE ONLY


Te Cene

Enance Te Dae
& Timing

Fo Viban Academ(I) P. Ld.


Ahoied Signae
Regd. Of f ice: Viban Academ(I) P. Ld. Viban Toe : A-14(A), Road No.1, Indapaha Indial Aea, Koa -324005 (Raj.) India
Tel No.: 0744-2423406, 2428664, 2428666, 3205261, 3205262, Fa:0744-2423405
Webie: .ibanacadem.com E-mail: admin@ibanacadem.com
1/23/12 Vibrant Academ(I) Pt. Ltd.
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If Pa Online Click here

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