|
Application Form |
|
To,
The
Director,
Inamdar Classes,Mumbai-400008
Please enroll me for
(tick the option you want) |
|
A. |
Group
Tuitions MHT - CET / Assoc. CET / MGIMS
2009 (for XII
th and repeater students)
|
24,000/- |
|
B. |
Crash Course MHT-CET
2009 (for XII
th and repeater students)
|
16,000/- |
|
|
Affix your
photograph here
| | |
|
NAME (IN BLOCK
LETTERS) |
|
|
|
SURNAME |
NAME |
FATHER'S NAME
| |
|
Address for
correspondence:________________________________________________________________________ |
|
_______________________________PIN
_________________Tel___________________E-Mail______________________ |
|
Name and
address of school/College:_________________________________________________________________ |
|
_______________________________________________________________________________________________________
| |
|
Standard_________
Date of Birth _______________ Category OPEN
| OBC | SC | ST | VJ
| NT1 | NT2 | NT3 |
|
Marks
Obtained: Xth Science _____/______
Mathematics ______/______ |
|
(If
applicable) XIIth
Physics _____/_____ Chemistry_____/_____ Biology
_____/_____ English _____/_____ |
|
Parent's/
Guardian's Name____________________________________________________________________________
Occupation_______________________________ Office
Address __________________________________ |
|
________________________________________________OfficeTel______________E-mail___________________________ |
|
Exams for
which you will be applying: Maharashtra CET, Assoc. CET MGIMS, CBSE,
AFMC, AIIMS, Any
other____________________________________________________________________________ |
|
I agree to abide by the rules and regulations of
Inamdar Classes. |
|
| Signature of student |
Signature of Parent
/ Guardian |
Date | |
|
Course
Chosen |
Fee Paid
|
Cash
|
Cheque / D.D
No., Dt
Name of Bank |
| |
|
|
| | |