Application Form

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Bansal Classes private limited A-10, “Gaurav Tower”, Road No.1, IPIA, Kota-324005 Course Applied for Application Form All Entries must be filled in capital letters only Reg. No. Test Centre 1st Preference Test Centre 2nd Preference Raipur (Bull’s Eye / Acme / Nucleus / Sterling) (Refer Information Brochure) After qualifying the selection test you wish to take admission at Test Centre for Bull’s Eye & Sterling Test Centre for Acme Test Centre for Nucleus Kota Chandigarh Mumbai Jaipur Dehrad
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  Affix latestPassport SizeColour Photograph Note: Center opted must be near to your current Local Address. Test centre once alloted wll not be chaned. Course Appled for After qualifying the selection test you wish to take admission at Kota Japur Ajmer Test Centre for   Agra   Ahmedabad   Ajmer Bhopal Chandigarh Dehradun Delhi Bull’s Eye & Sterln Jaipur Kolkata Kota Lucknow Mumbai Nagpur Pune Raipur Test Centre for Acme   Kota Jaipur Ajmer Delhi Test Centre for Nucleus   Kota Jaipur Ajmer Name:Date of Birth: Blood Group Gender: Male FemaleFather’s Name:Father’s Occupation: Designation: Deptt.:Address:City PIN Code Statee-mail: Mobile No.:Tel No. with STD Code: Resi.: Tel. Father’s office:Name of School with city where studying presently:Class in which studying as on date:Are you NTSE qualified: Yes No If yes, upto levelCategory: General Reserved If Reserved, please specify Past academc performance: Class Name of school Year Board Maths% Science% PCM% Aggr.%IX NA X NA  XI NA NA XII NA NAMenton the performance of prevous compettve examnaton, f any: (Bull’s Eye / Acme / Nucleus / Sterling) (Refer Information Brochure) Declaraton: I have carefully read the Academic, Administrative & General Rules and Regulations of the Institute as given in the Instruction Manual and agree to abide by thesame. I hereby declare that if I clear the Selection Test and join the institute by paying necessary Fees, I will abide the refund rules of the institute if I withdraw from the courseafter the expiry of refund date (as mentioned in Instruction Manual on Pont No. 20 & Overleaf of ths form ). I hereby declare that the information provided by me in the Ap-plication Form are true and correct to the best of my knowledge. My signature below certifies that i have read, understood and agree to the rules and regulation of the Instituteincluding those mentioned in Instruction Manual. All disputes are subject to Kota (Rajasthan) Jurisdiction. Re. No. Test Centre1 st PreferenceTest Centre2 nd Preference Enclose:    Photocopy of marksheet for last examinations passed  Admit Card duly completed by the applicant    Envelop duly wrtten canddates address & Courseyou are applyn for  Acknowledgement card duly filled Note : For sendn above, use the enclosed envelope addressed to us.  Selection Test paper will be in English only, however for STERLiNg course the Test Paperwill be made available in English & Hindi both.  Although, teaching & Course Material will be in English only.  Test Centre once allotted will not be changed. Snature (Father/guardan) wth dateSnature (Applcant) wth date You are advsed to retan a photocopy of the completed Applcaton Form for your records Application Form All Entres must be flled n captal letters only A-10, “Gaurav Tower”, Road No.1, IPIA, Kota-324005 Bansal Classes private limited  /19 /  D DM MY Y   F ee S tructure   Course Total Fee 1 Year Basic Course Fee S.T. @10.30% Caution Money DurationBull’s Eye 73,350* 66,500 6,850 -Na- Two YearAcme 73,350* 66,500 6,850 -Na- Two YearNucleus 74,901 67,000 6,901 1,000 One YearSterling 76,556 68,500 7,056 1,000 One YearAzusa 47,326 38,000 4,326 1,000 Three MonthLocus 4,412 4,000 412 -Na- As per course* This course fee is only for rst year during studying in class XI; course fee for 2nd year will be announced on 28th Feb. 2011. Dcrtio:   I have careully read the Academic, Administrative & General Rules and Regulations o the Institute as given in the Instruction Manual and agree to abide by thesame. I hereby declare that i I clear the Selection Test and join the institute by paying necessary Fees, I will abide the reund rules o the institute i I withdraw rom the courseater the expiry o reund date (as mentioned above). I hereby declare that the inormation provided by me in the Application Form are true and correct to the best o myknowledge. My signature below certifes that i have read, understood and agree to the rules and regulation o the Institute including those mentioned in Instruction Manual.All disputes are subject to Kota (Rajasthan) Jurisdiction. Signature (Father/Guardian) with dateSignature (Applicant) with dateYou are advised to retain a photocopy o the completed Application Form or your records      The above course fee does not include Hostel & School Fee.      Fee must be deposited only through Demand Draft or Pay Order. Cash and Cheque (even chequespayable at par at all branches in India) won’t be accepted.      Fee would be deposited in two installments, details of which will be given at the time of result onwebsite.      Sending Fax of the DD won’t reserve your seat; the DD in physical form must reach our ofce on orbefore last date, after the last date the admission would be automatically considered as cancelled.      Caution Money of Rs.1000/- is refundable only after student deposit Photocopy of IIT-JEE Application Form.     If there is any change in rate of Service Tax during the course period the same will be applicable and student will bear the same. RefunD Rules   A. On Application For Selection Test: Application Form Fee of Rs. 1000/- is not refundable under any circumstance whether you appear for selectiontest or not. Those sending the Demand Draft 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 studentmisses the selection test for any reason the application form fee will not be refunded. For any discrepancybefore selection test date student will call up our ofce for clarication. B. On Joining our Course: In case you discontinue our course due to some reason or the other, we will refund the fee as per following;no further request will be entertained under any circumstances.Course Last Date of Refund Refundable Amount out of rst installmentBull’s Eye 26-04-2010 75% of First Installment of Basic Course Fee (25% will be deducted)Acme 14-06-2010 75% of First Installment of Basic Course Fee (25% will be deducted)Nucleus 12-04-2010 75% of First Installment of Basic Course Fee (25% will be deducted)Sterling 05-07-2010 75% of First Installment of Basic Course Fee (25% will be deducted)    Date of fee refund is universal even in the following cases:    If you join late or after the date of refund is over.    If you don’t join or attend even a single class at all after depositing the course fee.  Refund is only possible out of the First Installment before the dates mentioned above.  No Refund is allowed in Second Installment.  No Fee will be refunded in case you leave after Last date of Refund mentioned above.  Our rules and regulations are applicable on you as mentioned here and in our latest brochure.  Refund request through Email / Fax / Telephone / Mobile / SMS will not be entertained; it should begiven in the prescribed format available with this brochure and the same must reach here on or before last   date of refund in physical form.    Refund rules are same whether you apply for refund without attending class.    Late joining does not allow students to get benet of 1 week time of refund.    For any legal dispute jurisdiction will be Kota (Rajasthan) only. GeneRal Rules  Student will attend their classes intheir own batches; non compliance of this will result into suspension of  one week.    lo o I-crd wi cot R.500/-  Change of Study Centre is notallowed.  If you leave the institute and rejoin,then 10% of basic fees will becharged additionally along withapplicable Service Tax on rejoining.  Commutation to institute will be the sole responsibility of thestudent. If any problem occursduring travelling to the instituteit is solely the responsibility of thestudent.  If the student indulges in any kind of unfair or unsocial activity, it isthe responsibility of the studentsand his parent only. The institutebears no responsibility for the same.    Dr Cod: stdt rrqird to wr obr coth(Gir hod tricty wr dctwr it with dptt d ic o o compic trywo’t b giv i th cmp).M tdt hod wrdct hirt with tror/pt.  Signature of applicant and father/ guardian on every sheet of  application form is must, otherwise form will be rejected.  Mobiles are not allowed forBoys. Girls can keep mobiles onswitched off mode in the campus.Male students found with mobileinside the campus will be ned as:First Time Rs.100/-, Second TimeRs.200/-, Third Time Rs.500 and after that Mobile will be forfeited forever.  Medium of instruction is Englishonly and all literature provided by us is solely in English.
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