Scribd
Upload
33 views

Application Form

The document is a student admission form for NIMES Education Services. It requests admission to their one year program for 2012-2013 and includes the student's personal details like name, date of birth, parents' names and occupation, address, contact information, educational qualifications and marks obtained. It also lists the terms and conditions of admission like providing photograph, marksheets, fees payment and agreement to the institute's policies. The student and guardian have signed agreeing to abide by the terms.

Uploaded by

varunkaran13
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
33 views

Application Form

The document is a student admission form for NIMES Education Services. It requests admission to their one year program for 2012-2013 and includes the student's personal details like name, date of birth, parents' names and occupation, address, contact information, educational qualifications and marks obtained. It also lists the terms and conditions of admission like providing photograph, marksheets, fees payment and agreement to the institute's policies. The student and guardian have signed agreeing to abide by the terms.

Uploaded by

varunkaran13
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 4

Enroll No:

To,
The Incharge
NIMES Education Services
Air Force Station
Subroto Park
New Delhi-110010

NM12.

ADMISSION
2012STUDENT CLASS CATEGORY

9th

10th

11th

12th

Affix your
recent
passport
size
photograph
here.

12th Passed

Respected Sir,
I want to take Admission in your institute One Year Program for the year 2012- 2013 Session. I
have read the Terms & Conditions of the Institute given overleaf and agree to abide to the same.
My particulars are given below:
(Please fill the form in CAPITAL LETTERS)
First Name______________________________________
Name________________________________________

Last

Fathers/Guardians Name
____________________________________________________________________________
Mothers Name_____________________________________________________________________________________
Occupation of
Father________________________________________________________________________________
Date of Birth_____________________________ Gender
Group_____________________

M or

Blood

Residence
Address__________________________________________________________________________________
(Permanent Address)
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Mobile_____________________________________ Email_________________________________________________
Phone (Any Other)_________________________________________________________________________________
School / College Name &
Address______________________________________________________________________
____________________________________________________________________________________________________
________________________________
5
10 %
Eligibility for Scholarship %
Because of
__________________________________________________________

Marks Obtained: Science_____________________________


CGPA in 9th /10th Class)

Maths__________________________ (% or

Please
Physics______________________________
Chemistry_____________________ (%
Attach
in 11ththe
/ 12th Class)
Photocopy
Maths________________________________ Biology_________________________ (% in
of Your
Mark
th
th
11
/
12
Class)
sheet

(FOR OFFICE USE ONLY)


AMOUNT (in
words)________________________________________________________________________________
Cash / Demand Draft No._________________________________________ Amount
(Rs.):_______________________
Drawn on:_________________________________________________________________________________________
Registration No______________________________ Office Receipt
No._______________________________________
Receipt Date:______________________________________________________________________________________

Terms & Conditions


1. Incomplete form will be rejected.
2. It is compulsory to attach photocopy of mark-sheet of the last qualifying
exam.
3. It is compulsory to attach three recent passport size photographs with the
admission form.
4. Any change of address should be notified in writing to the office without
delay.
5. The Institute reserves the right to make any change in its programme
without any prior
notice to anybody.
6. The Institute reserves the right to use the photograph for publicity in case
the student secures position / success in any Medical Entrance Exams.
7. The fee once paid will not be refunded under any circumstances.
8. In case of any dispute, arising out of present terms & conditions, same shall
be referred to the sole arbitrator to be appointed by the Chairman of NIMES.
The seat of arbitrator will be at Delhi only. In any case if any matter has to go
to the court, only Delhi Court shall have jurisdiction to decide such matters.
9. I have read the terms & conditions of the Institute as mentioned in the
brochure & promise to abide by the same.
10. Check list :
Three passport size photographs along with the form.
Photocopy of mark-sheet of the last qualifying exam.
Cash / DD in favour of NIMES payable at New Delhi along with the form.

(Signature of Parent/Guardian)
the student)

(Signature of

You might also like