8/16/2019 Insightiasacademy Admission Form

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North Delhi :  B-18, Satija House, Dr. Mukherjee Nagar - 110009

1. Roll No. in the Civil Service (Preliminary) Examination, 20......

2. Roll No. ...................................

3. Name of Candidate (in CAPITAL letters)

  ..................................................................................................

  ..................................................................................................

4. Date of Birth ................................................................

5. Category : ...............................................................

6. Name of Father .............................................................

7. Father’s Profession .......................................................

INSIGHT IASINSIGHT IASINSIGHT IASINSIGHT IASINSIGHT IAS AAAAACADEMYCADEMYCADEMYCADEMYCADEMY

REGULAR CLASSROOM PROGRAMMEREGULAR CLASSROOM PROGRAMMEREGULAR CLASSROOM PROGRAMMEREGULAR CLASSROOM PROGRAMMEREGULAR CLASSROOM PROGRAMME

ENROLMENT FORM

Ph. 011-45090051, 09818333201, 09871216382

Central Delhi : 102-103, Old Rajinder Nagar - 110060 

8. (a) Name of Mother ............................................................................................

(b) Mother’s Profession ............................................................................................

9.  Local Address ......................................................................................

  ......................................................................................

Contact No. ......................................................................................

10. Permanent Address .....................................................................................

  ......................................................................................

  ......................................................................................

11.  (a) Telephone No. (with STD code) ............................................................

  (b) E-mail address (if any) .............................................................

12.  Indicate language/ medium of Examination .............................................

  Affix your recent

  photograph

8/16/2019 Insightiasacademy Admission Form

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UNDERTAKING

This is to state that I........................................................................... son/daughter of .....................

..........................................................resident of............................................ am joining INSIGHT IAS

ACADEMY with complete knowledge of the Institute, its rules & regulations and code of discipline. I hereby

undertake that I shall abide by the rules & regulations and the discipline of the institute. In case of violation of the discipline or non-seriousness towards the studies, I can be terminated from the Institute without any claim

for the refund of fee. I am also aware of the fact that fee once paid to the institute are not refundable under any

circumstances even if I have to discontinue the course for personal reasons. The Institute shall have full

authority to use my name and other details for all promotional activities. I further undertake that I will neither 

allow any other institute to use my name nor associate with any other institute’s promotional activities for the

subjects/courses I have joined INSIGHT IAS ACADEMY.

 Date : Signature of the Candidate

 Examination Passed Board / University Subjects Year   Percentage of marks

13. Have you ever been selected in Civil Services on the basis of a CSE held in earlier years?

If Yes, Year of allocation of service /post .............................................

14.  Subject (s) which you wish to join in the Academy

(a) Preliminary ...........................................

(b) Main (I) .......................... (II) ........................... (III) ...........................

15. Which centre you wish to join in the Academy ( tick the choice )

(a) Old Rajinder Nager (b) Dr. Mukherjee Nager  

16. Particulars of all examinations passed commencing with matriculation or equivalent standard: