ENROLMENT FORM

Enrolment No. :
(For official use only)

Correspondence Programs

(To be filled by the student)

Name of Program Enrolling for : Preference of Test Centre for AITS for IIT-JEE / AIEEE++ :
(For list of test centres see page 2)

Please Affix Your Recent Passport Size Colour Photograph

Please mention your Enrolment No. in case you are already enrolled in any other FIITJEE program :

Name of the Candidate Father's/Guardian's Name Date of Birth

: : :
D D M M Y Y Y Y

Nationality :

Correspondence Address

Pin Ph. (Res.) with STD Code : Mobile No :

Permanent Address

Pin Ph. (Res.) with STD Code : School affiliated to Class : : CBSE VII VIII ICSE IX Mobile No : Others (Please Specify) XI XII XII (pass)

Marks in Sc + Math / PCM (%) Obtained : Category of Student E-mail ID of the Student : :

X Board General

XII Board

Others (Please specify) _________________________

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com

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Nearest relative / Guardian Address (to be contacted in case the candidate is not available at the above mentioned addresses) :

Pin Ph. (Res.) with STD Code : School Address (studying or passed): Mobile No:

Pin Phone. : TEST CENTRES$ FOR ALL INDIA TEST SERIES (AITS) for IIT-JEE, 2011 / 2012 (Only one centre can be opted.) : Delhi (South), Delhi (North-West), Delhi (East), Delhi NCR (Gurgaon), Delhi NCR (NOIDA), Delhi NCR (Faridabad), Delhi NCR (Ghaziabad), Agra, Ahmedabad, Ajmer, Allahabad, Amritsar, Aurangabad, Bangalore, Bareilly, Bathinda, Bhagalpur, Bhilai, Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dehradun, Dhanbad, Durgapur, Gorakhpur, Guwahati, Gwalior, Hisar, Hyderabad, Indore, Jabalpur, Jaipur, Jammu, Jamshedpur, Jhansi, Jodhpur, Kanpur, Karnal, Kharagpur, Kochi, Kolkata, Kota, Lucknow, Ludhiana, Meerut, Mumbai (Kandivali), Mumbai (Sion), Mumbai (Thane), Muzzafarpur, Nagpur, Patiala, Patna, Pune, Ranchi, Rohtak, Roorkee*, Rourkela, Shakti Nagar NTPC, Siliguri, Thrissur, Trivandrum, Udaipur, Ujjain, Vadodara, Varanasi, Vijayawada & Vishakapatnam.
Above are the test centres for All India Test Series for IIT-JEE only. (For centres of Concept Strengthning & Analysis Program (CSAP), please contact your nearest FIITJEE Centres.) * Roorkee is the test centre only for Open Test.
$

TEST CENTRES* FOR ALL INDIA TEST SERIES for AIEEE++, 2011 / 2012 (Only one centre can be opted.) : Delhi, Allahabad, Amritsar, Bangalore, Bathinda, Bhilai, Bhopal, Bhubaneswar, Bokaro, Chandigarh, Chennai, Dhanbad, Durgapur, Hyderabad, Indore, Jaipur, Jamshedpur, Kanpur, Kolkata, Kota, Lucknow, Mumbai, Muzaffarpur, Nagpur, Patna, Pune, Ranchi, Rourkela, Shakti Nagar NTPC,Vadodara, Varanasi & Vishakapatnam.
*

Open Test for AIEEE++ will be held at all centres of All India Test Series for IIT-JEE / AIEEE++.

Note : All India Test Series (One Year & Two Year) and All India Test Series for AIEEE++ (One Year & Two Year) is also available by Correspondence (All the Test Papers to be received & attempted at your home.)

Course Fee payment details : Demand Draft No. Drawn on Bank Dated Amount

CHECK LIST 1. Photocopy of X / XII board marksheet* VI school final exam marksheet (for Target NTSE in The Box Two Year Program) VII school final exam marksheet (for Target NTSE in The Box One Year Program) VIII school final exam marksheet (for ASCENT in The Box) 2. Photographs colour (3 passport & 1 stamp size) 3. Demand Draft for course fee * In case of claim for scholarship in Rankers Study Material program the X / XII marksheet / NTSE certificate is to be attested by the past or present school Principal.
FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com
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For IIT-JEE, 2012 I am interested in enrolling for (Tick the appropriate box) Rankers Study Material (One Year Version) One Year All India Test Series One Year All India Test Series
(By Correspondence)

For IIT-JEE, 2013 I am interested in enrolling for (Tick the appropriate box) Rankers Study Material (Two Year Version) Two Year Integrated All India Test Series Two Year Integrated All India Test Series
(By Correspondence)

All India Test Series (for Class XI only)

For AIEEE, CET(Karnataka) CET(GGIPU) & BVP (PUNE), WBJEE, BCECE etc., 2012 I am interested in enrolling for (Tick the appropriate box) One Year All India Test Series for AIEEE++

For students of class IX aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad & Foundation IIT-JEE / KVPY / Other Competitive Exams I am interested in enrolling for (Tick the appropriate box) Jr. Rankers Study Material

Place: __________________ Date: _______________

Note 1 : Note 2 : Note 3 : Note 4 : Note 5 : Note 6 : Note 7:

(Signature of the Student)

(Signature of the Parent / Guardian) Name ________________________________________ Relationship with the student _____________________

Fee of any program is not refundable at any stage. All India Test Series is part of Rankers Study Material. You need not enrol for it separately in case you are enrolling yourself for Rankers Study Material. All India Test Series for AIEEE++ is a part of Correspondence Course for AIEEE++. You need not enrol for it separately in case you are enrolling yourself for Correspondence Course for AIEEE++. Please write your name behind your photograph and your name & address behind the demand draft. The Demand Draft for course fee for all the above mentioned IIT-JEE programs except Open Test should be in favour of "FIITJEE LIMITED - TS, RTPF, GMP A/c" payable at New Delhi. In case of Open Test the draft should be in favour of FIITJEE LIMITED Open Test, Aptitude Test etc. A/c payable at New Delhi. Demand Draft for course fee of Correspondence Course for AIEEE++ (One / Two Year Version) / One Year All India Test Series for AIEEE++ / Two Year Integrated All India Test Series for AIEEE++ should be in favour of FIITJEE Ltd - ASM A/c payable at New Delhi. Photocopy of this form can also be used.

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com

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Last date to receive completed applications for following programs for IIT-JEE, 2012
Rankers Study Material (One Year Version) One Year All India Test Series One Year All India Test Series (By Correspondence) : : : : : 31th August, 2011
Despatches are done fortnightly to all new enrolments.

10th October, 2011 17th October, 2011

Last date to receive completed applications for following programs for IIT-JEE, 2013
Rankers Study Material (Two Year Version) Two Year Integrated All India Test Series Two Year Integrated All India Test Series
(By Correspondence)

: 20th September, 2011

Mailing commences from April, 2011

: 18th November, 2011 : 25th November, 2011 : 18th October, 2011

All India Test Series (for Class XI only)

Last date to receive completed applications for following programs for AIEEE++, 2012

One Year All India Test Series for AIEEE++

23rd October, 2011

Last date to receive completed applications for following program for students aspiring to excel in IX, X, Jr. Science Olympiad / Math Olympiad & Foundation IIT-JEE / KVPY / Other Competitive Exams
Jr. Rankers Study Material : 30th September, 2011

FIITJEE Limited, FIITJEE House, 29 A, Kalu Sarai, Sarvapriya Vihar, New Delhi-110016 Ph: 011-4610 6068 /00 /10 /13 /15 All India Toll Free No. : 1800 11 4242 Fax: 011-2652 5337 Website:www.fiitjee.com

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