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E n r o l m e n t F o r m
Enrolment Number (for official use only)
( f o r C l a s s r o o m / I n t e g r a t e d S c h o o l P r o g r a m s )
2
Enrolment Form
Please Note :
v Check the availability of the program at your preferred FIITJEE centre before making a choice.
v MakeaphotocopyofthisformafterfillingtherequiredinformationandbeforesubmittingittoFIITJEE.
v Logontowww.fiitjeelogin.comtoupdateyourContactDetailsonlineusingRegistrationNumberandwebaccesscodeprintedon
your Hall Ticket.
Items required to be submitted along with this form :
v Six identical passport size colour photographs of the student (One photograph should be pasted on this page, Two on page no. 14 and
Three photographs should be submitted along with this Enrolment Form).
v One stamp size photograph (should be pasted on page no. 14).
v AdmissionTest/BBE/FTRE/FTSE/Fortunate-40HallTicket(inOriginal).
v Admission offer letter (in Original).
v Any one of the following documents :
n PhotocopyofSchoolIDcardwithphotographor
n Photocopy of last Board or School Marksheet supported by any Identity Proof of student or
n PhotocopyofTransferCertificateor
n BonafidecertificateissuedbythePrincipalofSchoolwithstudent’sphotograph
Original should be presented for verification at the time of admission.
Instruction for filling Enrolment Form
Pleasereadcarefullythe“ImportantInformationforStudents(&theirParents/LegalGuardians)”and“Declarations/Undertakings”sectionon
pageno.10,11&12respectivelybeforefillingthisForm.
In order to serve you even better, please share your valuable opinion below
What has influenced you the most to join FIITJEE ? {Pls tick (ü) options relevant to you}
FIITJEE Results / Achievements � FIITJEE Value System � FIITJEE Faculty � if yes, Name of FIITJEE Faculty : .........................................................................................
FIITJEE Student � if yes, Name of FIITJEE Student : .........................................................................................
His / Her FIITJEE Program Name : .........................................................................................
FIITJEE Study Centre Enrolled at : .........................................................................................
If any other influence (please specify) : ............................................................................................................................
.............................................................................................................................................................................................
u
3
Enrolment Form
Registration Number (as mentioned on the Hall Ticket) :_______________________________________________
Study Centre : _________________________________________________________
Program Name (refer page no. 13 & 14) : ________________________________________________________________________
Program Code (refer page no. 14 & 15) : ________________________________________________________________________
Scholarship Awarded % (if applicable) : ________________________________________________________________________
Student’s Name (in Block Letters) : _______________________________________________________________________________________
Date of Birth : ________/_______/___________ E-mail ID :_________________________________________________
Mailing Address : _______________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________
Contact No (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________
Permanent Address (if any) : _______________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________________________ Pin :_________________________________
Contact No. (Mobile) : ____________________________ Land Line (with STD Code) : ___________________________________
School/College Last Attended / Presently Attending : _____________________________________________________________________
Address : _______________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________
(a) Father‘s Name : ________________________________________________ Qualification : _________________________
Occupation : Business � Govt. Service � Pvt. Service � Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________
Nature of Business / Job : ____________________________ Designation : _____________________________________________
Department : ____________________________ Contact No (office) : _________________________________________
Office / Business Address : _______________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________
E-Mail ID : ________________________________________________ Mobile No : ___________________________
(b) Mother‘s Name : ________________________________________________ Qualification : _________________________
Occupation : Business � Govt. Service � Pvt. Service � Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________
Nature of Business / Job : ____________________________ Designation : _____________________________________________
Department : ____________________________ Contact No (office) : _________________________________________
Office / Business Address : _______________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________
E-Mail ID : ________________________________________________ Mobile No : ___________________________
Please affix the 1st passport size colour
photograph of the student here
Test date : ______/______/_____________
4
Enrolment Form
(c) Details of the Local Guardian reference (Mandatory if the student is joining as a hosteler)
Local Guardian’s Name : ________________________________________________ Qualification : ________________________
Occupation : Business � Govt. Service � Pvt. Service � Others (please specify) : __________________________
Name of the Company / Office : _______________________________________________________________________________________
Nature of Business / Job : ____________________________ Designation : _____________________________________________
Department : ____________________________ Contact No (office) : _________________________________________
Office / Business Address : _______________________________________________________________________________________
_________________________________________________________________________________ Pin : _________________________________
E-Mail ID : ________________________________________________ Mobile No : ___________________________
Mailing Address : _______________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
_________________________________________________________________________________ Pin: _________________________________
(d) Details of the Sibling(s) (if applicable)
1. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
2. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
3. Name : _______________________________________________________________________________________
Class studying in : ___________________________ Enrolment No. (if enrolled with FIITJEE) :_________________________
Name of the Examination(s) Board Year of passing / appearedTotal
Aggregate Marks (%)
PCM / Science + Math
(%)
Details of the examination(s) of the class last passed / currently studying
Detail(s) of Demand Draft(s) / Pay Order(s)
S. No. Instrument Number Dated Issuing Bank & BranchFee
Amount GST Total Amount
1
2
3
4
Total
Fee Details : Fee Plan opted (√): I □ II □ III □ IV □
Fee Plan Code : _______________________________________ (please refer course fee Annexure)
5
Enrolment Form
Annexure “A”
TERMS & CONDITIONS FOR POST DATED CHEQUE(S)
I understand that if my son /daughter / ward withdraws from the Program to which he/she has been admitted
at any point of time or does not attend the Program and thus the seat given to him/her is rendered vacant,
thesamewillnot/cannotbefilledupbyanyothercandidateandavacancycreated in thebatchdue to
withdrawalofastudentafterthestartingofclassesorupto2dayspriortothesamecannotbefilledinany
case,thereforeIunderstandthatFIITJEEshallsufferirreparablelossesincaseofnon-paymentofremaining
feeoftheinstalmentplan,henceitwillbeunethicalnottohonourthePostDatedCheque(s).Ihaveopted
forinstalmentfeeplanandhavesubmittedthePostDatedCheque(s)asperthedetailsgivenbelow.
Iagreethat, Iwillmakearrangement, forbelowstatedPostDatedCheque(s),togethonoured,andwill
keepsufficientfundsonorbeforetheduedateforthesame.
Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted)
S. No. Cheque No. Dated Issuing Bank Fee Amount GST Total Amount
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
Affix one self attested passport sized
photograph of the person issuing Post Dated
Cheque(s) i.e. parents / guardian
6
Enrolment Form
I further agree to get above PostDatedCheque(s) cleared, even if,my son / daughter /ward discontinues studies at FIITJEE,irrespective of any reasons.
I am signing the above declaration in good mental / physical health. I have satisfied myself about FIITJEE. The necessary Enrolment-Forms,includingthisformwasreceivedbymeseveraldaysbeforetheactualdateofsigningtoenablemetounderstandtheimplicationsoftakingadmissionatFIITJEE.IhavetakenexpertopinionregardingmatterswhichwerenotcleartomeandIamsatisfied.
SignatureoftheStudent Father/Mother/LegalGuardian’sSignature
Name : ____________________________________________________ {Whohasissuedthecheque(s)}
EnrolmentNumber(for office use only) : __________________________ Name : ______________________________________
Date : _____________________________________________________ Address : ____________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Date : _________________________________ Father/Mother/LegalGuardian’sSignature
Place : _________________________________ Name : ______________________________________
Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted)
S. No. Cheque No. Dated Issuing Bank Fee Amount GST Total Amount
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Annexure “A”
7
Enrolment Form
Annexure “B”
CONSEQUENCES OF DISHONOUR OF POST DATED CHEQUE(s)
Iunderstandthatnon-clearanceofanyofthePostDatedCheque(s),submittedforpaymentoffees(oninstallmentbasis)asmentioned
intheEnrolment-Formandannexure“A”ispunishableunderSec.138oftheNegotiableInstrumentAct.IunderstandthatFIITJEE
shallbeentitledtoproceedandinitiateappropriatelegalactionagainstme,torecovertheamountofthePostDatedCheque(s)along
with the legal expenses and out of pocket expenses incurred by FIITJEE.
IncaseanyofmyPostDatedCheque(s)bouncesforanyreasonwhatsoever,IundertaketosubmitaDD/Pay-Orderinfavourof
“FIITJEELtd.”payableatNewDelhi,withinfourdaysofthebouncingoftheCheque(s)atmybank,togetherwithRs.500/-(Rupees
fivehundredonly)asdefaultmoneyalongwith latepaymentofRs.50/- (Rupeesfiftyonly)perdayupto10(Ten)days fromthe
due date of payment of instalment after which my son / daughter / ward shall be debarred from classes without any further notice
and I shall have no claim for refund of fees or any support in studies besides Legal action inter alia action under Section 138 of the
NegotiableInstrumentActmaybeinitiatedagainstme/us.
SignatureoftheStudent Father/Mother/LegalGuardian’sSignature
Name : ____________________________________________________ {Whohasissuedthecheque(s)}
EnrolmentNumber(for office use only) : __________________________ Name : ______________________________________
Date : _____________________________________________________ Address : ____________________________________
_____________________________________________
_____________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Date : _________________________________ Father/Mother/LegalGuardian’sSignature
Place : _________________________________ Name : ______________________________________
8
Enrolment Form
Excellent Good Average Below Average Low Unknown
Sincerity
Leadership
Imagination
Emotional stability
Ability to work with others
Ability to work hard
Perseverance
Annexure “C”
PARENT DATA SHEET
(CONFIDENTIAL)
DearParent/ Guardian,
The right and accurate feed back of your ward/student will give us an opportunity to understand the student better which will help us
inprovidingbettersupport&education.Thisinformationwillbeconfidential.
1. NameoftheStudent : ______________________________________________________________________________
2. Father’s/Guardian’sName : ______________________________________________________________________________
3. RelationwithStudent : ______________________________________________________________________________
4. Howwouldyouratethestudentinthefollowingcharacteristics?(√theappropriate)
6. Whatisthestudent’sclassrank? : ____________________________________________________________________________
7. Somegiftedindividualsmakemediocrescholasticrecords.Isthestudent’srecordanaccurateindexofhis/hercapabilities?
Yes/No
If no, state why? : ______________________________________________________________________________
8. Whatisthestudent’sbiggestweakness?: ______________________________________________________________________
9. Havetherebeenanymajorchangesinthestudent’sattitudetowardsstudiestillnowatanytime,ifsoillustrate,whenandwhy?
(You may attach a blank page if required.)
10. Pleasementionanyotherinformationrelatingtothestudent,whichhelpmakeFIITJEEunderstandthestudentbetter.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
11. My son / daughter / ward has a sound moral character & sense of responsibility. He/she also has good physical and mental health
tosuccessfullycopeup&completehis/herstudiesatFIITJEEandfulfillallterms&conditions.
Father/Mother/LegalGuardian’sSignature
Date : _________________________________
Place : _________________________________
9
Enrolment Form
Annexure “D”
Kindly do not take admission at FIITJEE if the clauses of the declaration on the Enrolment Form on page no. 11 & 12
is not agreeable to you.
NameoftheStudent : _________________________________________________________________________________________
NameoftheFather/Parent/Guardian: ___________________________________________________________________________
Residentialaddress : ___________________________________________________________________________________________
Specific Declarations (10 & 22) are being reproduced hereunder :
Declaration 10 :
In addition to the above, I understand without any ambiguity, that the fee once paid is not refundable at all, whatever the reasons be,
neitherisitadjustabletowardsanyotherexistingcoursesatFIITJEEoranyyettobelaunchednortowardsthefeeofanyotherexisting
or prospective student.
Declaration 22 :
I/We,theparent/guardianand/orthestudent,herebyseverallyandjointlydeclareunambiguouslythatI/Wehavereadandunderstood
alltheclausescontainedinthisEnrolmentform,AnnexureandDeclarationsandagreetoabidebythemwithoutanyreservationor
ambiguity.
I/We further declare that the above named student is taking admission in the ____________________________________________
___________________________________________________(course opted for) having considered everything material and on his/her
own sweet will and with the permission of the Father / Mother / Legal Guardian without any coercion from any side.
SignatureoftheStudent Father/Mother/LegalGuardian’sSignature
Name : ____________________________________________________ Name : ________________________________________
EnrolmentNumber(for office use only) : __________________________ Address : _______________________________________
Date : _____________________________________________________ ________________________________________________
I have retained photocopy of this document for my reference before submitting it at FIITJEE.
Date : _______________________________ Place : _____________________________ Father/Mother/LegalGuardian’sSignature
Instruction : Afterfilling-upannexure“A”,“B”,“C”&“D”pleaseretainphotocopyofthesamebeforesubmittingattheFIITJEE
Checklist : 1.DemandDraft(s)/PayOrder(s)forthefee �
2.Local/atparpostdatedcheque(s) �
3.EnrolmentFormdulyfilledin �
4.Annexure“A”to“D” �
5. Colour Photographs:
(a) Passport size (Six) �
(b)Stampsize2.5x2cm.(One) �
6.AdmissionTest/BBE/FTRE/FTSE/Fortunate-40HallTicket(inOriginal) �
7. Admission offer letter (in Original) �
8. Any one of the following documents :
(a)PhotocopyofSchoolIDcardwithphotographor �
(b) Photocopy of last Board or School Marksheet supported by any Identity Proof of student or �
(c)PhotocopyofTransferCertificateor �
(d)BonafidecertificateissuedbythePrincipalofSchoolwithstudent’sphotograph �
10
Enrolment Form
IMPORTANT INFORMATION FOR STUDENTS (and their parents / legal guardians)
1. BeforeTakingAdmission-EachCandidate,His/HerParents&LegalGuardiansarerequiredto-
(a) GothroughtheFIITJEELeaflet/Brochure/InformationBooklet,wordofadvice,selectionletter&websitethoroughly.Otherthanthese
no other verbal assurance of any kind is given by FIITJEE.
(b) ItisadvisedthatstudentundergoesacomprehensiveMedicalExaminationtoensurethathe/sheisphysically&mentallyfittotakethe
rigors of preparing for a competitive exam including but not limited to JEE Advanced & JEE Main etc. as the case may be.
(c) MeetfewFIITJEEstudentssuccessful inIIT-JEE/AIEEE{nowJEEAdvanced&JEEMainrespectively},NTSEetc&learnwhatmade
themsuccessful.WhatwasthecontributionofFIITJEE intheirsuccess? Alsomeeta fewFIITJEEstudentsnotsuccessful in IIT-JEE/
AIEEE{nowJEEAdvanced&JEEMainrespectively}/NTSE&learnwhytheycouldnotqualifyIIT-JEE/AIEEE{nowJEEAdvanced&
JEEMainrespectively}/NTSE.
WehighlyadvisethatyoualsotalktoNon-FIITJEEstudentsbothsuccessfulinIIT&theunsuccessfulones,toformaclearopinionregarding
what a coaching institute can do for you.
Please do not take admission at FIITJEE if you think FIITJEE is not the best for JEE coaching.
Anintelligentstudenthavingaptitude&analyticalskillsforJEE/NTSEetchastohaveselfstudyforatleast3hrs.foreveryhourtaughtat
FIITJEE.Needlesstosayifyouhavenotbeenahighlyanalyticalstudentyouhavetoputinevengreaterefforts.
For success in JEE, it is also important to have excellent performance In XII Board Exams. Furthermore, JEE is a different exam where you
will feel lost if you do not focus on fundamentals and/or you do not develop / have high analytical skills. Any amount of effort will be in vain
without high analytical skills. Admission at FIITJEE does not mean that you have high analytical skills. FIITJEE teachers will guide you in such a
way that your fundamentals are strengthened and you can improve your analytical skills tremendously, whether it happens or not will depend
upon you. The only way to develop strong fundamentals & improve your analytical skills & therefore your chances to get through JEE Main /
JEEAdvanced/NTSE,etcwithexcellentSchool/Boardperformanceistosolveeach&everyprobleminFIITJEEassignmentsyourself.You
mayhavetomakeseveralattempts&evengobacktoyourbasicstorefreshthemtosolveaparticularproblem.Itisthisintensity&quality
ofeffortwhichwillhelpyoudevelopgoodanalyticalskills.Ultimatelyastudentwhoisenrolledwithinstitutewillhavetocontinuouslywork
hard and must be regular in studies. In case, the teachers feel that the student is not working hard, is creating indiscipline in the Institute,
is irregular in attendance or is not responding properly, he/ she may be expelled from the institute. The decision of FIITJEE in this regard
will/shallbefinalandbindingonthestudents.Nofeeorpartofthefeewillberefundedinsuchcase.
In the end remember, while anyone can appear in JEE Main / JEE Advanced or pretend to prepare but only the ones who walk the right path will
succeed. FIITJEE has no magic potion to make you successful. Preparing to achieve optimum performance in both Boards & JEE will challenge
every bit of your mental & physical energies.
2. FIITJEEstartsmakingarrangementsof infrastructure, faculty&other resourcesabout6monthsbeforecommencementoffinancial year.
FIITJEEadmitsstudentsasperitscapacityplans,(subjecttounforeseencircumstances&usualorganizationalrisks)thereforeeachstudent
taking admission has to pay complete fee under all circumstances i.e. even if he/she discontinues for any reason whatsoever or parents /
guardiansbetransferred.Notallstudentswhositinouradmissiontestareofferedadmissionthereforeyou&parentshavetobeverysure
before taking admission as you have to pay complete fee under all circumstances.
OnceaclassstartsFIITJEEdoesnotadmitanystudents.Therefore,anyvacancycreatedbyastudentleavingcannotbefilledup.SinceFIITJEE
has to source infrastructure, faculty etc. in advance, loss of fees of students leaving after taking admission will compel the institute to enhance
fees for next batch of students which is unfair to them. Therefore, students / parents must clearly understand this important aspect and take
admissiononlyiftheyarefullysatisfied.
3. Any change in government rules, regulations, policies pertaining to the courses of competitive exam such as JEE Main / JEE Advanced,
Olympiads,KVPY,NTSEetc.whichmayrendertheseexamsasdeletedorcancelled.Insucheventuality,FIITJEEshallnotbeheldresponsible
in any manner whatsoever. However, FIITJEE shall take all necessary steps to protect the interest of students.
Student’s Signature Signature of Father / Mother / Legal Guardian
Name : _________________________________ Name : _________________________________
Date : __________________________________ Date : __________________________________
Place : __________________________________ Place : __________________________________
11
Enrolment Form
Kindly do not take admission at FIITJEE, if the following declarations are not agreeable to you
Please read the Declarations / Undertakings carefully before signing
Declaration:
1. I/We hereby declare that the information furnished on this enrolment form etc. is correct to the best of my knowledge and belief.
2. IamtakingadmissioninFIITJEEwiththeconsentofmyFather/Mother/LegalGuardianandafterbeingsatisfiedinallrespects.
3. I/We undertake that the information / details furnished / given by me/us are correct and if any discrepancy is found in the said details / information, atanystageofmyassociationwithFIITJEE,FIITJEEmaytakeanylegalactionagainstme/uswhichFIITJEEmaydeemfitincludingbutnotlimitedto my (student) expulsion from the institute and I/We shall not be entitled for any refund of fees / claim / compensation / damages etc.
4. I/Weundertakethat I/Weshall furnish / submit /complete theremainingrequireddocumentsand formalitiesbyat least twodaysprior tocommencement of course program. However if I fail to do so, FIITJEE may not allow me to attend the classes, unless otherwise allowed by FIITJEE in writing. I/We further undertake that I/We shall not claim any refund of fees/ cost of study material etc. already paid on ground of inability to furnish/complete documents / formalities.
5. I/We understand and acknowledge that FIITJEE does not give any guarantee / promise / assurance for success in JEE Main / JEE Advanced / XIIboards, inspiteofprovidingthebestteachingfacultyandmethodology,duetohigh-endcompetitionand limitednumberofseats in IIT. I undertake that I shall not hold FIITJEE responsible if I may not succeed the JEE or other competitive exam.
6. I/Weunderstandandacknowledgethatpreparationfor JEErequiresexhaustivehardwork,extensivestudy,motivationandselfconfidence. IundertakethatIshallfollowtherulesandteachingmethodologybesidestudyandpracticerigorouslywithoutloosingself-confidence.
7. I/WeclearlyunderstandthatFIITJEEoncompletionoftopicstobecoveredbyFIITJEEinClassXIasperit’splan,willdogoalrefocusingforallTwoYearClassroomProgramstudentsincludingPINNACLEprogramstudentstohelpeachstudentachievemaximumpossiblesuccess.Thismeans that some students based on their performance, may have to predominantly focus on exams other than JEE (Main & Advanced).
8. I undertake that if I leave the institute midway before completing the full course for any reason whatsoever, including but not limited to transfer of my Father / Mother / Legal Guardian / ill health of myself or any other member of the family or my admission in any institute / course / engineering college etc., or my studentship is cancelled because of misconduct etc., I or my Father / Mother / Legal Guardian shall not be entitled for refund of fees.
9. I/WeundertakethatonceI(student)jointhestudycentre/programofferedbyFIITJEE,I/Weshallnotbeentitledtochangethestudycentre/programnorwillIbeentitledtorefundoffees.However,ifFIITJEEfindsmecompetent/eligibleforthehighercourse/program,itmayconsidermyrequestforchangeofprogramsubjecttopaymentofdifferenceofcourse/programfee.
10. Inadditiontotheabove,Iunderstandwithoutanyambiguitythatthefeeoncepaidisnotrefundableatall,whateverthereasonsbe,norisitadjustabletowards any other existing courses at FIITJEE or any yet to be launched nor towards the fee of any other existing or prospective student.
11. IundertakethatIshallabidebytherules®ulationsofFIITJEEorFIITJEE’sassociatedschools.Iundertakethatincaseofanydisputerelatingtobreach/violationofanyoftheRules&RegulationsofFIITJEEorFIITJEE’sassociatedschool,thedecisionoftheManagementofFIITJEEshallbefinalandbindinginallcircumstancesandsituations,whatsoever.
12. ItisunderstoodthatthisadmissionisvalidonlyforthecourseandthedurationforwhichIamtakingadmissionandI/We(thestudentandtheParents/LegalGuardian)shallnotclaim/requestforadmissiontoandadjustingthefeestoanyothercourseorduration.
13. I/We acknowledge that the course materials provided to the student by FIITJEE during the course of study at FIITJEE are the intellectual property of FIITJEE and solely for personal purposes and not for commercial use. I further undertake that I shall not make copies of the study material provided by FIITJEE nor shall provide / give / distribute it to anyone else.
14. FIITJEEhasenjoyedgreatrelationshipwiththestudentsandparents.Almostallstudentsineveryclassandeveryprogramhavebeensucceedingin coping up with huge pressure of simultaneous preparation for competitive exams along with school / board studies. In few cases where some students do discontinue because they are not able to cope up with simultaneous competitive exam preparations along with school / board studies, the parents have continued to support the good work of FIITJEE.
Whatwillconstitutedeficiencyinservice?
Iftheaveragefeedbackoftheparticularsubjectteachergoesbelow70%intheFeedbackForm“Annexure-FB”(attachedherewith),thenthesaidteacherwillbeconsideredtoteachbelowtheminimumFIITJEEStandard.Ifateachergetslessthan70%feedbackintwoconsecutiveperiods then his/her teaching will be considered unsatisfactory by high FIITJEE standards.
15. I/WehavefullysatisfiedourselveswithregardstoqualityandexcellenceofteachingatFIITJEEfromallavailableinformation/sourcesandhavedecided to study only at FIITJEE. I/We wish to pay the entire fees as per the Fee Plan ____________ (Fee Plan I / Fee Plan II / Fee Plan III) option (the same is signed by me & the student and is attached with this enrolment form) at our own sweet will and convenience without any pressure / coercion from any one.
16. I/WeagreetosubmitaphotocopyoftheJEEAdmitCardofthestudentby25thMarchoftheconcernedJEEyeartoFIITJEEandadmitcardofvarious Other Engineering Entrance Exam as soon as I/We receive the same from the examining body.
Student’s Signature Signature of Father / Mother / Legal Guardian
Name : _________________________________ Name : _________________________________
Date : __________________________________ Date : __________________________________
Place : __________________________________ Place : __________________________________
DECLARATIONS / UNDERTAKINGS
12
Enrolment Form
17. I/We fully understand that FIITJEE is giving the scholarship because the student is expected to bring laurels to FIITJEE and will spread good word ofmouthamongthestudents. I/WeundertakethatI /weshall /will fullycooperatetoachievethisobjectiveincludinggivingtheJEEAdmitCardbefore25thMarchoftheconcernedJEEyearandsigningtheletterofappreciationlaudingFIITJEEefforts.I/Wefurtherundertakethat I/We shall attend the seminars / workshops / felicitation / interview etc. conducted by FIITJEE after achieving rank by the student; however FIITJEE shall alone bear the entire cost and expenses in respect thereof. I further undertake to endorse the efforts and contributions made by FIITJEEInachievingtherankwhilegivingInterviewstothemedia(print/electronic/web).IfwefailtogivetheJEEadmitcardby25thMarchofthe concerned JEE year, FIITJEE will have the right to discontinue the scholarship and/or recover the scholarship with interest and the student / parents/legalguardianwillhavenoobjectiontothesame.
18. I/We (student and the parents) declare that FIITJEE will have sole claim over the outstanding academic performance of the student and further agree to give a letter of appreciation to FIITJEE for the outstanding result in form of a Letter, a Video Interview or any other forum / format that FIITJEEdeemsfit.
19. I/We undertake and acknowledge that incase I/We indulge in any kind of litigation with FIITJEE, I/We shall not be entitled for any Awards / Rewards/Scholarships/Benefitsetc.fromFIITJEEandshallrefund/returnsuchAwards/Rewards/Scholarships/Benefitsetc.Ifavailedbythestudent, within a period of 15 days, failing which FIITJEE shall be entitled to recover the same through the appropriate court / forum alongwith interest, damages and cost of litigation.
20. I/WeundertakethatI(student)shallnotindulgeinanyillegal/unethical/unprincipled/immoral/corrupt/dishonestactivitieswhichmaycause loss of property, reputation and goodwill of FIITJEE. I/We further undertake that I/We shall compensate for/ indemnify against any loss /damage caused to FIITJEE.
21. IfastudentisawardedscholarshipbyFIITJEEanddoesnotperformatasimilarlevelafterjoiningFIITJEEClassroom/IntegratedSchoolProgramthenaprobemaybelodgedtofindoutifthestudentgotscholarshiponhis/herownmeritorbyusinganyunfairmeans.ParentsandGuardiansofthe student will be liable to pay back full fee of the program (that the student is enrolled for) with interest plus expenses towards investigation and alsoacompensationofRs.10Lacs,iftheinvestigatingcommitteeconcludesthatstudenthadnotsecuredthescholarshiponhis/herownmerits.
Therefore, if your child has got scholarship using unethical means please do not take admission at FIITJEE.
22. I/We,theparent/guardianand/orthestudent,herebyseverallyandjointlydeclareunambiguouslythatI/WehavereadandunderstoodalltheclausescontainedinthisEnrolmentform,AnnexureandDeclarationsandagreetoabidebythemwithoutanyreservationorambiguity.
23. I/We furtherdeclare that the studentnamedonpageno.3 is taking admission in theprogramasmentionedonpage3havingconsideredeverything material, on his/her own sweet will after giving due consideration to rigors of time, distance and studies ahead and with the permission oftheFather/Mother/LegalGuardianwithoutanycoercionfromanyside.FurtherI/Weunderstandthatthestudentisrequiredtoworkhardtoattaintheaveragestandardofthebatchallottedinordertocopeupwithstudiesandputinextraeffortsiflaggingbehindinanysubject/topic.
24. I/Wefurtherundertaketoensurethatcheques/draftsincludingpostdatedchequesifanygivenbyuswillbehonouredbyourbankers.Intheeventofthesecheques/draftsbeingdishonoured,FIITJEEisatlibertytoinitiateanyactionagainstusincludinglegalproceedingsundersection138ofNegotiableInstrumentsActorotherappropriatelaw.
25. IknowthatregisteredofficeofFIITJEELtd.issituatedatNewDelhi.
26. IpromisetoabidebyallrulesandregulationsofFIITJEEdeclaration,inletterandspirit.
27. Intheeventofanydisputebetweenthepartiesregardingtheinterpretationofclausesofenrolmentformoranyclaimetc.arisingoutoftaking admission in FIITJEE, the matter shall be referred to the Sole Arbitrator appointed by FIITJEE Ltd. The arbitration proceedings shall beconductedinaccordancewiththeprovisionsoftheArbitration&ConciliationAct,1996andstatutorymodificationthereof&rulesmadethereunder.ItisfurtheragreedthatinspiteofthefactthattheSoleArbitratormaybeknowntoanyoftheDirectorsorshareholdersandthathemayhavebeendealingwiththeCompanyorhadoccasiontodealwithanymatterofthisagreementshallnotdisqualifyhim.EveniftheArbitratormayhaveexpressedopinioninsimilarmatterearliershallalsonotrenderhimdisqualified.Thearbitratorsoappointedshallnot be incapacitated for reasons of their being the employee or an associate of FIITJEE Ltd. or Group / Subsidiary Companies, and for reasons ofhavinganypriorlinkagewiththecompany.Thedecisionofthearbitratorshallbefinal&bindingonbothparties.ThevenueofArbitrationshallbeDelhi/NewDelhionly.
28. Subject to clause27 above, I/We (the student and theFather /Mother / LegalGuardian)understand that in caseof any legal dispute, thejurisdictionwillbeanappropriatecourt/foruminDelhi/NewDelhionlyandI/Weshallnottakerecoursetosuchanactioninanyothercourt/forumoranywhereelse.IncaseIdo,Ishallinformtherelevantcourt/forumregardingthisjurisdictionconstraint.
29. Ihavereadtheabovecarefullyandhaveunderstooditclearly.I/WehavealsoreadthecurrentFIITJEEBrochurecarefullyandhaveunderstooditclearly.IhavekeptaphotocopyofallthepagesofthisenrolmentformincludingthisdeclarationandAnnexures“A”,“B”,“C”&“D”formyfuture reference and timely compliance.
Additional declaration for Integrated School Program Students only :
30. I/We(Studentandtheparent)am/arejoiningFIITJEE’sIntegratedSchoolProgramonlyaftersatisfyingmyself/ourselvesaboutthestructureofprogram.I’llfullyabidebytherulesandregulationsoftheschool.IalsounderstandthatintheeventIamexpelledfromtheschoolonany
disciplinarygroundI’llraisenoclaimfromFIITJEEforanyacademicand/orfinanciallossincludingcoursefee..
Student’s Signature Signature of Father / Mother / Legal Guardian
Name : _________________________________ Name : _________________________________
Date : __________________________________ Date : __________________________________
Place : __________________________________ Place : __________________________________
DECLARATIONS / UNDERTAKINGS
13
Enrolment Form
(DeclarationtobegivenbythestudentifFather/Mother/LegalGuardiandoesnotresideintheStudyCentreCity,neitherdoeshe/she have any Local Guardian)
As my Father / Mother / Legal Guardian do(es) not reside at _______________________________________ and I have no Local
Guardian. I own all responsibility on their / his / her behalf.
Date : _________________________________ Student’s Signature : ________________________________
Place : _________________________________ Name : _______________________________________________
(To be struck off, if Not Applicable)
(DeclarationtobegiveniftheEnrolmentformisnotsignedbytheFather/Mother/LegalGuardianatthetimeofadmission)
I have received an extra copy of this Enrolment Form, which I shall send to my Father / Mother / Legal Guardian and submit to
FIITJEE within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the FIITJEE authorities
in writing, my admission shall be liable to be cancelled and I or my Father / Mother / Legal Guardian shall have no claim for refund
of fees or any other compensation of any type.
Date : _________________________________ Student’s Signature : ________________________________
Place : _________________________________ Name : _______________________________________________
(To be struck off, if Not Applicable)
For Office use only
Check list for the Accountant / Admission Coordinator.
v NameoftheAccountant/AdmissionCoordinator: _____________________________________________________________
v TheApplicationformiscompleteinallrespectwithAnnexureA,B,CandDdulysignedbythestudentandtheparent.
v The details of the scholarship offered.
o Cash scholarship (If any) : _______________________________________________________________________________
o Fee Waivers offered (If any) : ___________ %on ____________________________________________________ ground
o Hostel fee waiver (If any) : ______________________________________________________________________________
v Thecertificatespertainingtoscholarshipareattached.
v 6 passport size and one stamp size photograph are attached.
v Late payment charges / Admin. charges duly calculated and collected.
v Thefeechargedhasbeendulymatchedandverifiedwiththefeebrochure.
v SignaturesonPDCsandonAnnexureA,B,CandDaresame.
v IsthestudentjoiningasaHosteler?IfyesdetailsoftheLocalGuardianareprovided.
v The student has been offered the admission after selection in Admission test only.
DeclarationbytheAccoutant/AdmissionCoordinator.
IhaveverifiedtheentireEnrolmentformandcheckedallthepointsmentionedabove.TheEnrolmentisrecommended.
Date : _______________________ Place : _________________________ Signature of the Account / Admission Coordinator
DECLARATIONS / UNDERTAKINGS
14
Enrolment Form
Program NameProgram
Code
For Admission in Class 6th
LITTLE GENIE - One Year Foundation Program - Regular Week Contact Classes 6051
LITTLE GENIE - One Year Foundation Program - Weekend Contact Classes 6052
LITTLE GENIE - One Year Foundation Program - Sunday Contact Classes 6053
For Admission in Class 7th
UDAYA Plus - Two Year Integrated School Program 7010
UDAYA - Two Year Classroom Program - Regular Week Contact Classes 7051
UDAYA - Two Year Classroom Program - Weekend Contact Classes 7052
UDAYA - Two Year Classroom Program - Sunday Contact Classes 7053
For Admission in Class 8th
UDAYA - One Year Classroom Program - Regular Week Contact Classes 8051
UDAYA - One Year Classroom Program - Weekend Contact Classes 8052
UDAYA - One Year Classroom Program - Sunday Contact Classes 8053
For Admission in Class 9th
SUPREME - Four Year Integrated School Program for JEE Advanced 9020
ATHENA - Four Year Integrated School Program for JEE Main 9022
Four Year Classroom Program for JEE Advanced - Regular Week Contact Classes 9061
Four Year Classroom Program for JEE Advanced - Weekend Contact Classes 9062
Four Year Classroom Program for JEE Advanced - Sunday Contact Classes 9063
Four Year Classroom Program for JEE Advanced - Regular Week Contact Classes (Admission only for Class IX and X) 9064
Four Year Classroom Program for JEE Advanced - Weekend Contact Classes (Admission only for Class IX and X) 9065
Four Year Classroom Program for JEE Advanced - Sunday Contact Classes (Admission only for Class IX and X) 9066
Four Year Classroom Program for JEE Main - Regular Week Contact Classes 9071
Four Year Classroom Program for JEE Main - Weekend Contact Classes 9072
Four Year Classroom Program for JEE Main - Sunday Contact Classes 9073
For Admission in Class 10th
Three Year Classroom Program for IIT-JEE - Regular Week Contact Classes 1061
Three Year Classroom Program for IIT-JEE - Weekend Contact Classes 1062
Three Year Classroom Program for IIT-JEE - Sunday Contact Classes 1063
Three Year Classroom Program for JEE Advanced - Regular Contact Classes (Admission only for Class X) 1064
Three Year Classroom Program for JEE Advanced - Weekend Contact Classes (Admission only for Class X) 1065
Three Year Classroom Program for JEE Advanced - Sunday Contact Classes (Admission only for Class X) 1066
Classroom / Integrated School Programs
Please affix the 2nd passport size colour
photograph of the student here
Please affix the 3rd passport size colour
photograph of the student here
Please affix the stamp size colour
photograph of the student here
Please submit 3 additional passport
size colour photographs with this
Enrolment Form
15
Enrolment Form
Program NameProgram
Code
For Admission in Class 11th
PINNACLE - Two Year Integrated School Program for IIT-JEE 1110
PINNACLE - Two Year Integrated Program for IIT-JEE (Jr. College) 1112
Two Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1151
Two Year Classroom Program for JEE Advanced - Weekend Contact Classes 1152
Two Year Classroom Program for JEE Advanced - Sunday Contact Classes 1153
Two Year Classroom Program for JEE Advanced - Special Weekend Contact Classes 1154
Two Year Classroom Program for JEE Advanced - Regular Week + Sunday Contact Classes 1155
Two Year Classroom Program for JEE Main - Regular Week Contact Classes 1171
Two Year Classroom Program for JEE Main - Weekend Contact Classes 1172
Two Year Classroom Program for JEE Main - Sunday Contact Classes 1173
Two Year Classroom Program for JEE Main - Special Weekend Contact Classes 1174
Two Year Condensed Classroom Program for IIT-JEE -Regular Week Contact Classes 1161
Two Year Condensed Classroom Program for IIT-JEE -Weekend Contact Classes 1162
Two Year Condensed Classroom Program for IIT-JEE - Sunday Contact Classes 1163
For Admission in Class 12th
One Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1251
One Year Classroom Program for JEE Advanced - Weekend Contact Classes 1252
One Year Classroom Program for JEE Advanced - Sunday Contact Classes 1253
One Year Classroom Program for JEE Advanced - Regular Week + Sunday Contact Classes 1254
One Year Classroom Program for JEE Main - Regular Week Contact Classes 1271
One Year Classroom Program for JEE Main - Weekend Contact Classes 1272
One Year Classroom Program for JEE Main - Sunday Contact Classes 1273
One Year Classroom Program for JEE Main - Regular Week + Sunday Contact Classes 1278
Special One Year Weekend Classroom Program 1261
Special Weekend Classroom Program for IIT-JEE 1262
Intensive Contact Program for JEE Advanced 1264
Special One Year Classroom Program for JEE Main & Advanced 1266
Intensive Contact Program for IIT-JEE 1281
Super Rank Enhancement Classroom Program for IIT-JEE 1282
Crash Course for JEE Main 1286
For Admission After Class 12th
One Year Extended Classroom Program for JEE Advanced - Regular Week Contact Classes 1351
One Year Classroom Program for JEE Main - Regular Week Contact Classes 1371
One Year Classroom Program for JEE Advanced - Regular Week Contact Classes 1361
Special Classroom Program (for Ex-FIITJEEians) 1362
Intensive Contact Program for IIT-JEE 1381
Super Rank Enhancement Classroom Program for IIT-JEE 1382
Crash Course for JEE Main 1386
Classroom / Integrated School Programs
Enro
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.e.f.
Apr
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National Admissions Office : FIITJEE House, 29-A, Kalu Sarai, Near Hauz Khas Metro Station, Sarvapriya Vihar, New Delhi - 110 016
Ph. : 011 - 49283471 / 73 / 75 All India Toll Free No. : 1800 11 4242 Email : [email protected] Web : www.fiitjee.com
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