vpm classes application form 2012-13
TRANSCRIPT
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 : [email protected]
APPLICATION FORM
Registration No.:(for official use only)
