KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP    ...
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP3.Mo...
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP8.Re...
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP11....
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP13....
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP15. ...
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP17.E...
KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP   ...
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Admission form

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THIS IS A GENERAL ADMISSION FORM OF KSHITIJ EDUCATION INDIA

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Admission form

  1. 1. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP Application Form (Target Exam – IITJEE/AIEEE/AIPMT) Latest Photograph Course Applying ForKshitij Kshitij Kshitij Kshitij Kshitij Kshitij Kshitij Kshitij Kshitij KshitijE - 13 E-12 E-11 M-13 M-12 M-11 B-12 B-12 F-10 F-9 PCM PCB1.Name of the Applicant2.Father’s Name Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  2. 2. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP3.Mother’s Name4. State of Domicile5.Date of Birth Date Month Year6.Gender Male Female7.CategoryGeneral OBC SC ST DS PD Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  3. 3. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP8.Religion9.Permanent Address10.Address of Correspondence (All studymaterials and test papers will be sent at thisaddress) with phone/mobile number Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  4. 4. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP11.Medium of Studies to be opted in KshitijEducation India Hindi English12.Past Performance in Competitive/TalentExaminations, fill if relevalentS. Competitive Year Level Max Marks % Remarks,No Or Talent (Qualified) Qualified Marks Obtained Marks (AIR) (ASR) if any Examination (1/2/Final)1. NTSE2. Olympiads3. KVPY4. IITJEE5. AIPMT6. AIEEE7. Other Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  5. 5. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP13.Parent’s/Guardian’s Occupation14.Past four year’s Acadmic PerformanceClass Year of Name City/Town/Village District State Board % % Passing of the Marks/Grade Marks/Grade Out School Aggregate in PCM/B1211109 Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  6. 6. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP15. Address and Phone No. of Class 10School16.Address and Phone No. of Class 12School Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  7. 7. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance ExamsDelhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP17.Emergency Mobile No./Email (otherthan Parents) Name Mobile No. Email18.How did you come to know about KshitijEducation India? (Write in 30 words)19.Parents/Guardian’s Bank AccountDetailAccount Relationship Account Bank City BranchHolder’s with Numbername Student Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com
  8. 8. KSHITIJ EDUCATION INDIAFOR IITJEE/AIEEE/Medical Entrance Exams Delhi | WB | Bihar | Noida | Gurgaon | MP | CG | AP | UP DeclarationI/We undersigned, hereby assure that the information given in the application form (as well as in allrelevant documents i.e. Cheques, Demand Drafts etc.) is true and correct. I/We have understood andagreed that my misrepresentation or concealment of facts will justify the denial/cancellation ofundesired student’s admission, or expulsion from the institute at any stage of the academic session.Ihave read and hereby provide my/our free consent to the terms and conditions of application form andmentioned on the website for admission is the institute for the academic session 2012-2013 further, ifundersigned is admitted I/We promise to abide by all the rules and regulations and norms of disciplineof the institute as long as undersigned student remains a registered student of Kshitij Education India.I/We hereby also declare that while being an enrolled student of Kshitij Education India, undersignedstudent will be responsible in terms of providing relevant details of all the competitive examination(in form of true photocopies of the application form of the relevant examination) while he/she will beappearing in the future by virtue of coaching and academic support from the institute. If theundersigned student, as registered student succeeds in any of these competitive examination, KshitijEducation India will have all the rights of using his/her result, photo graph and testimonials in anyform for its growth strategies and development plans. In such cases I/We never have any objection orprotest for this.Signature of Student Signature of ParentDate:- Date:-Place:- Place:-Note:- In case of any dispute, the Jurisdiction of the Court of Delhi will be applicable Corporate Office- B-206, Sec. 7, Dwarka, Palam Extension, New Delhi-110045 Contact No. – 011 64599348, 011 64739348, 011 64599348, 011 65659348 Email Id- info@kshitij-iitjee.com, info@kshitij-pmt.com, info@kshitij-school.com Website- www.kshitij-iitjee.com, www.kshitij-pmt.com, www.kshitij-school.com

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