Brilliant-35 Cash Form

Form No.
TM
JRS TUTORIALS
A Premier Coaching Institute for
IIT- JEE (Main & Advanced) and NEET-PMT
JRS Bhavan, Durgakund, Varanasi -z2toos
Ph. No. (0542) 2311777, 2311922, 3290510
Registration Form
For Oflice Use Only
Candidate's Name:
Course
Enrollment No.
I.D. No.
Fee deposited Rs.
on
Balance
(if any) Rs.
to be paid on
Candidate's Name
Aflix
mml-l-|-tl
Date of Birth
cEN!
Crtegory
oBcI
Sex:
M/T
r.n
latest passpon
Size
Photograph
.tn
Father's Name
Occupation
Mother's Name
Permanent Address
st"t"l-__-l
Code
:
Correspondence Addrest
:
Ph. No. with STD
Dtutrict
Parents
Mob, No.
st"t"l-___l
:
Local
Ph. No. with STD
Code
:
Mob.
website : rvww.jrstutorials.ac.in e-mail : [email protected]
,l'
Where from you came to know about JRS :
L News Paper: Dainik Jagran
Hindustan
Times of
2.
rv
fI
India
3. Friend
[-l
[
Hindustan Times
+. ex-tns
Student
f]
Amar Ujala
!
Rastriya Sahara
Aaj n
Dainik Bhaskar
fl
5. Any other
Details of Examinations Passed / Appeared :
of
Name
Name of Board
Errmination
Year
Name ofthe Institution
(with complete address)
70 of Marks
obtained in
7o Marks in
(Aggregrtc)
Instt. Name
",r1,;;1""
Instt. Nam€
lntermediate
Physics .....,,..,,.,,
(+2)
chemistry ,....,.,...
Maths,rBio .......,.,,
Distt.
Others
l.
Admission right is reserved with Director of the Institute and admission is done on the
basis of performance in
admission test.
drawn in favour of .JRS Tutorials', payable at varanasi.
2.
All drafts and cheques should
J.
Fees once deposited shall
depositing the fee.
A
Any act of indiscipline, misconduct or misbehavior on part of student will attract punishment
and it may also
result in cancellation ofregistration. In such case no refund of fee will be admissible.
).
Stud.ents are required
be
not be refunded in any
casc,
You are requested to satisfy yourself before
to bring the ldentity card while coming to institute. students without ldentity
card will not
be allowed to attend the class.
6.
All disputes are subject to Varanasi Court Jurisdiction.
hereby declare that informations given by me in this apptication form
are correct.
I further declare that I will follow all the rules and regulations of the Institute.
Signature ofthe Parent / Guardian
Signature of the Candidate
Date: ...........
Place: .,..,..,...,
Enclosures: (i) Six passport size photographs (ii) Copy of mark sheeUcertilicate
of examinations passed
JRS Tutorials, Durgakund, Varanas