ASTRAL EDUCATION ACADEMY(A venture by Astral Heights Group) www.UgcNetCoaching.com

1. Your Name

2. Date of Birth

3. Phone No. (with STD Code)

4. E-Mail Address.............................................................................................

5. Qualification Details :

6. Your Present Occupation................................................. 7. Father’s/Husbands Name............................

8. Correspondence Address (Please mention the address on which you want the material to be sent,

also mention landmarks so that courier should reach you without any inconvenience)

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...................................................................................................................Ph..................................................

9. Permanent Address

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(Mob.)

D D M M Y Y

Form No._____________(To be filled by us)

Affix a recent coloredpassport size

photograph here.

Do not staple or pin

Do not write anything on photograph

REGISTRATION FORM FOR UGC NET CORRESPONDENCE COURSES

PLEASE FILL COMPLETE FORM IN CAPITAL LETTERS

DEGREE / COURSE(SPECIALISATION & DURATION ALSO)

UNIVERSITY / BOARDPASSING

YEAR

PG

UG

XII

Any Other

% AGE/ CGPA/GRADE

10. Expected Net Exam Appearing Date 11. Exam Centre/Code

12. Net Roll No. (if already applied)

16. Course Type : Normal Correspondence Test Series Fast Forward

17. Source of Information : Google / Online Ad / Face Book / Pamphlet / Hording / Friend / Other...................................

..........................................Signature of the Student

Please fill in Payment Deatils (Please attach Payment Receipts)

FEES DEPOSITED.......................................

TRANSACTIONS NUMBER..........................

MODE OF PAYMENT................................

BANK BRANCH......................................

PAYMENT DATE..........................

..........................................Name of the Student

..........................................Date

13. Previous Net Result (if any)

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DECLARATION : I have read and understood all the terms & conditions written in this form as well as in the website, email, brochure, prospectus, pamphlets

etc. I also know that the fees paid by me will not be refunded / transferred/ adjusted under any circumstances. By signing, I allow you to use my information/ Photograph for your advertisement purpose on any of the medium used by you. I also know that I do not have any rights to reproduce / resell / Xerox / Photostat / Scan / or any other way or give away to study material/ prints notes / class notes of the institute and they are solely the property of Astral Education Academy and its owner company. I hereby declare that I will abide to all said terms & conditions, in any case I am found guilty of it, my candidature can be cancelled immediately and fee paid by me will be fully forfeited as well as I can be legally penalized also & will be responsible to pay all the losses occurred due to my irresponsible activity.

14. Subject Code/Name.............................................................

15. Specialization / Elective.......................................................