FEE STRUCTURE* NTSE TEST SERIES FOR STAGE-II 2017 500/-
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Corporate Office "SANKALP", CP-6, IndraVihar, Kota (Rajasthan)-324005 Trin : +91-744-516-2200, 515-6100 E-Mail : [email protected] APPLICATION FORM NTSE TEST SERIES FOR STAGE-II Academic Session 2016-17 ALLEN Form No. CCP DLP DEMAND DRAFT DETAILS No. : _____________________________ Dated : ___________________________ Bank : ___________________________ __________________________________ Amount (in Rs.) : __________________ Amount (in Words) :________________ __________________________________ Test Center Name : ________________________________________________________________________ Student Name : ________________________________________________________________________ Father’s Name : ________________________________________________________________________ Mother’s Name : ________________________________________________________________________ Date of Birth : Gender (Tick) : Male Female Category (Tick) : GEN SC ST EX PH OBC SOBC Postal Address : ________________________________________________________________________ ________________________________________________________________________ __________________________________ City__________________________________ State : __________________________________ Pin Code _____________________________ Contact No. : (STD Code)___________________ (Phone No.)_________________________________ Mobile No.(s) : (1)__________________________________(2)_________________________________ E-mail Address : (For important updates)___________________________________________________ D D M M Y Y Y Y FEE STRUCTURE* Course Name Total Amount Payable (Inclusive Service Tax) Course Code (ENGLISH Medium Only) Affix here a Recent Passport Size Color photograph. Please do not staple. DECLARATION I hereby declare, 1. that I have read the instructions of Test Series and I agree to abide by the Rules & Regulations as amended by institute time to time. 2. that I am seeking admission in my own interest and accord. 3. that all information furnished by me in Application Form etc. is correct. I understand that in the event of any information found to be incorrect of false, my admission may be cancelled without any refund of fee. 4. that I will be responsible for my rustication on behalf of my misconduct / misbehave at test center. 6. that in case of my selection in NTSE Exam, the institute reserves the right to use my information for publicity. FORM No. (For Office use only) 500/- 5. that I will submit the photocopy of NTSE 2017 Stage - I & II Admit Card at Test Center. Date : / / 20 Signature of Candidate 4171 Are you CCP/DLP Student of ALLEN during session 2016-17 ? If yes, please complete the following information *CCP/DLP Students of Session 2016-17 need not to pay Fee for this Test Series. NTSE 2017 Stage-I Roll No.: NTSE 2017 Stage-II Roll No.: IMPORTANT : Attach zerox copy of your NTSE 2017 Stage - I Admit Card with this form. Failing which your form may not be processed. Place : ___________ Signature of Parent/Guardian This Application Form is also available on our website : www.dlp.allen.ac.in (In BLOCK Letters) NTSE TEST SERIES FOR STAGE-II 2017 FORM No. (For Office use only)
Transcript of FEE STRUCTURE* NTSE TEST SERIES FOR STAGE-II 2017 500/-
Corporate Office"SANKALP", CP-6, IndraVihar, Kota (Rajasthan)-324005Trin : +91-744-516-2200, 515-6100 E-Mail : [email protected]
APPLICATION FORMNTSE TEST SERIES FOR STAGE-II
Academic Session 2016-17
ALLEN Form No. CCP DLP
DEMAND DRAFT DETAILS
No. : _____________________________
Dated : ___________________________
Bank : ___________________________
__________________________________
Amount (in Rs.) : __________________
Amount (in Words) :________________
__________________________________
Test Center Name : ________________________________________________________________________
Student Name : ________________________________________________________________________
Father’s Name : ________________________________________________________________________
Mother’s Name : ________________________________________________________________________
Date of Birth :
Gender (Tick) : Male Female
Category (Tick) : GEN SC ST EX PH OBC SOBC
Postal Address : ________________________________________________________________________
________________________________________________________________________
__________________________________ City__________________________________
State : __________________________________ Pin Code _____________________________
Contact No. : (STD Code)___________________ (Phone No.)_________________________________
Mobile No.(s) : (1)__________________________________(2)_________________________________
E-mail Address : (For important updates)___________________________________________________
D D M M Y Y Y Y
FEE STRUCTURE*
Course Name Total Amount Payable (Inclusive Service Tax)Course Code
(ENGLISH Medium Only)
Affix here a Recent
Passport Size
Color photograph.
Please do not staple.
DECLARATION I hereby declare,
1. that I have read the instructions of Test Series and I agree to abide by the Rules & Regulations as amended by institute time to time.
2. that I am seeking admission in my own interest and accord.
3. that all information furnished by me in Application Form etc. is correct. I understand that in the event of any information found to be
incorrect of false, my admission may be cancelled without any refund of fee.
4. that I will be responsible for my rustication on behalf of my misconduct / misbehave at test center.
6. that in case of my selection in NTSE Exam, the institute reserves the right to use my information for publicity.
FORM No.
(For Office use only)
500/-
5. that I will submit the photocopy of NTSE 2017 Stage - I & II Admit Card at Test Center.
Date : / / 20 Signature of Candidate
4171
Are you CCP/DLP Student of ALLEN during session 2016-17 ?If yes, please complete the following information
*CCP/DLP Students of Session 2016-17 need not to pay Fee for this Test Series.
NTSE 2017 Stage-I Roll No.: NTSE 2017 Stage-II Roll No.:
IMPORTANT : Attach zerox copy of your NTSE 2017 Stage - I Admit Card with this form. Failing which your form may not be processed.
Place : ___________ Signature of Parent/Guardian
This Application Form is also available on our website : www.dlp.allen.ac.in
(In BLOCK Letters)
NTSE TEST SERIES FOR STAGE-II 2017
FORM No.
(For Office use only)
