vpm classes application form 2012-13

 Date:.................................. Signature (Student):…………………..

CSI R UGC NET, GATE ( ENGI NEERI NG), GATE ( Science) , I I T-JAM, UGC NET, TI FR, I I Sc, NI MCET, JEST etc.  

Which type of course you wish to enrol for? Please tick ()

CORRESPONDENCE COURSE TEST SERIES OTHERS

YEAR: 2012 2013 2014 2015 | (for NET students only):   June December

EXAM NAME:  ___________________________________________  SUBJECT: _____________________________________________ 

PERSONAL INFORMATION (All the fields are compulsory; Please fill only in BLOCK LETTERS): 

Name of the Candidate: __________________________________________________________  Sex:  Male  Female 

Date of Birth: DD______/MM______/YYYY_________  Father’s Name: _____________________________________________________ 

Correspondence Address: ___________________________________________________________________________________________ 

 ____________________________________________________________________________________________________________________ 

Ph. (Res.) with STD Code: __________________________________  Mobile No. ________________________________ 

E-mail ID of the student: ______________________________________________________________________________________________ 

Educational Background:  ( Please fill aggregate % Marks) 

Exam passed Name of school/collegeBoard of

EducationYear ofpassing

% of Marks Rank/Class

X

XII

B.Sc/ B.Tech

M.Sc /M.Tech

Other

Course Fee payment details:Demand Draft(DD)

No./ NEFT No./ CashDeposit

Drawn on Bank Amount

Registration procedure:Submit your application form along with 2 recent passport-size colour photographs, Xerox copy of 10

th, 12

th, Bachelor & Master degree mark sheets &

demand draft(DD) drawn in favour of “VPM Classes” payable at any bank at KOTA, RAJASTHAN. Send all the items to the VPM Classes postaladdress (mentioned in the top left box of this form). For NEFT/Cash Deposit kindly use VPM CLASSES A/C No. (Mentioned above).

Note: Fee of any program is not refundable at any stage.

DECLARATION1. I declare that all the information furnished in this Application Form is correct to the best of my knowledge. I understand that in the event of any

information found to be incorrect or false, my admission may be cancelled without refund of fee.2. I will provide VPM Classes with the details (Roll Nos. etc) of the entrance exams which I may appear in the future. I shall not withhold this

information from VPM Classes, who are entitled to know the results of their efforts to help me get through the exams. VPM Classes reservesthe right to use the photograph for publicity if I am successful in the Entrance Exams.

3. All legal disputes are subject to jurisdiction of the Courts / Authorities of Kota, Rajasthan only. 

DETAILS PNB HDFC

VPM CLASSES A/CNo.

4148001800000019 18462560000284

RTGS/NEFT IFSCCode

PUNB0414800 HDFC0001846

Branch NamePNB, Nagar NigamBranch, Kota, Raj.

HDFC, TalwandiBranch, Kota, Raj.

Please AffixYour Recent

Passport SizePhotograph

Address : VPM CLASSES1-C-8, SFS, Talwandi,Kota (Rajasthan) -324005Ph. (0744) 2429714, 09001297111Website : www.vpmclasses.com  Email :   info@vpmclasses.com

APPLICATION FORM 

Registration No.:(for official use only)