517, 5th Floor East Wing Arora Towers, Mg Road Camp Pune-411001 Tel: 8208182665

APPLICATION APPLICATION
FOR ADMISSION FOR ADMISSION
COURSE: VENUE: _______________
DATE: ________________

______________________________________________________________________

(Surname) (Name) (Fathers Name) (Mothers Name)

HOME ADDRESS:_________________________________________________

________________________________________________________________

Tel: ______________________ EMAIL:____________@_________________

Date Of Birth: _ _/__/____ Age:_______ SEX: MALE FEMALE

Std. in Which Studying: _____ STREAM: Arts Science Commerce

MARKS IN SSC/CBSC/ICSC/HSC/IGSC ______ MATHS: _______________

SCIENCE: _______ Agg. %: _____________

FATHERS NAME: (in full) ________________________________________________

Profession: Service / Business Designation:__________________

Company Name: _____________________ Department:___________________

Company Address:______________________________________________________

____________________________________________ Tel:_________________

I am Closing A _____________ Balance Payment A _____________

(This Admission Card is request towards
Being admitted for given course. I have read
all the rules and regulations and undertake
to abide by them.) Signature of Parent/Student/Legal Guardian
 Declaration
1. I hereby declare that the information in the admission form is correct to the best of my knowledge and belief.
2. If any discrepancy in the information given or otherwise is found at any stage of my association with SHIKSHA
PLUS, any action deemed fit by
SHIKSHA PLUS including my expulsion from the institute may be taken against me. In such a case I or my father /
mother / legal guardian shall have
no claim for any type of compensation/refund of fees.
3. I am taking admission in SHIKSHA PLUS with the consent of my father / mother / legal guardian, after studying
SHIKSHA PLUS brochure and being satisfied in all respects.
4. I understand that if I fail to compete / submit all remaining formalities/documents. If any, up to two days prior to the
start of the classes, unless otherwise allowed
in writing. I shall not be allowed to attend the classes till the needful is done.
5. I understand that if I leave the institute before completing the full course for any reason whatever, including:
(i) Transfer of father / mother / legal guardian s/ill health of myself or any other member of the family or
(ii) Timing inconvenient
(iii) Does not want to continue
(iv) Medical reasons
(v) My admission in any institute / course / engineering college
Myself, my father/mother/legal guardian shall have no claim for refund of fees.
6. In addition to the above, I understand without any ambiguity that the fee once paid is not refundable at all,
whatever the reasons be, nor is it adjustable towards any other existing courses at SHIKSHA PLUS or any
yet to be launched nor towards the fee of any other existing or prospective student.
7. It is understood that this admission is valid only for the course and the duration to which I am taking admission and
I/We (the student and the parents) shall not claim/request for adjusting the fees to any other course or duration.
8. I promise to abide by all rules and regulations of SHIKSHA PLUS declaration, in letter and spirit.
9. I/we further declare that the above named student is taking admission in the SHIKSHA PLUS having considered
everything material, on his own sweet will after giving due consideration to rigors of time, distance and studies ahead
and with the permission of the father/ mother / legal guardian without any coercion from any side.
10. I/we further undertake to ensure that cheques/drafts including post dated cheques if any given by us will be
honored by our bankers. In the event of these cheques/drafts being dishonored, SHIKSHA PLUS is at liberty to
initiate any action against us including legal proceedings to include invoking provisions of section 138 of Negotiable
instruments Act.
11. I have read the above carefully and have understood it clearly; I have kept a photocopy of the all page of this
enrollment from including this declaration for my future reference and timely compliance.

Date : _____________ Countersigned by father/ mother/ legal guardian Signature Student Signature

Place : _____________ Name : _________________ Name:_________________

FOR OFFICE USE ONLY

SP. REMARKS: _____________________________________________________________

___________________________________________________________________________

BASIC COURSE FEES: ___________________ Approved By_________________

PHOTO
Receipt No Cash/Cheque Date Remarks