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Application Form

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Candidate Details
Name Hrithikesh Kenche
Date of Birth 2002-03-14 Gender M
Father's Name ramesh kenche Current Class XI Undergoing
Mother's Name shobha rani
flat no. 3c , krupadeep apts, rd no. 6 ,
Address
mahindrahills,secunderabad,hyderabad,telangana
City secunderabad State Telangana
Pincode 500026
Mobile 9949123311 Mobile2 ______________

Registration and Purchase Details


User ID rameshkenche5@gmail.com Order ID 334765
Transaction Date/Time 2018-04-29 18:12:42 Payment Mode online
Online Txn/DD No. NSBI6261808461 Amount Rs 3900
Note: Enclose DD with this application in case payment mode is demand draft

Application No. Courses Purchased Course Code Scholarship Code Fee


Nurture - Online Test Series for JEE Main
18650138 1121 N/A Rs 3900
and Advanced 2020

Declaration
I hereby accept that no refund will be made if I join ALLEN's Online test series by paying the prescribed fee.
I hereby declare that the information provided by me in this form are true to the best of my knowledge.
If I get selected in Pre-Medical Exams or Pre-Engineering Exams or Talent/Olympiad Exams or any Competitive
exams then ALLEN Career Institute can publish and display my name and photograph.
All disputes are subject to Kota (Rajasthan) Juridiction only.

Date: ______________ Place: ______________

Signature with date (Applicant) Signature with date (Father/Guardian)

Send the complete application form along with all required enclosures to the following address :
Administrator (E-learning Division)
ALLEN Career Institute
SANKALP, CP-6
Indra Vihar Phone: +91-744-2750275 (10:00 AM to 08:00 PM)
Kota - 324005 Email: support@onlinetestseries.in
Rajasthan, India

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