Name of the Applicant (Exactly as in Class-X Certificate) : 5. Date of Birth : 4.
Name of one Parent/Guardian (As per Class-X Certificate) : dd ... Ready
Reckoner.
For Office Use Deposited Rs. : __________________________________________ on A/C of (course name) : _________________________________ Material given by hand : IIT-JEE- RB
(For Classroom Coaching Students of VIJETA Course Opting Test Centre Out Side Kota)
Reso Roll. No. :
RM
Important Instructions : Use only CAPITAL LETTERS of English language to complete the Application Form. Use only Black/Blue Ball Point/Gel Pen to complete the Application Form. An Application Form carrying incomplete information may be rejected by the Institute.
Course : Batch :
3. Name of the Applicant (Exactly as in Class-X Certificate) :
5. Date of Birth :
4. Name of one Parent/Guardian (As per Class-X Certificate) :
yy mm dd 6. Date of Student's departure : yy
mm
dd 7. Applicant's Correspondence Residential Address (Do not write your/your Father's Name) :
City/Town/P.O. :
District :
State : Tel. No. :
Pin Code : Mobile No. :
0 (STD Code)
0
(Telephone No.)
E-mail :
8. Which tests do you want to apply for in session 2011-12 ? (Tick Test Option
Test Date
*MT-1 (VIJETA / VISHWAS)
01 Jan'2012
*MT-2 (VIJETA / VISHWAS) OT (IIT-JEE) OT (AIEEE) MT (VIJAY) JPT-1 *JPT-2 JPT-3 APT-1 *APT-2 APT-3
* It will be conducted in LIVE Mode at Study Centers only. | Online Test are available in English medium only. | Please attach Photocopy of your class room I-card, two photos (passport size) & photocopy of IIT-JEE / AIEEE application form along with this application form.
