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Student Name *
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City and Country *
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Mobile No. (with ISD Code) *
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Email ID *
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Father's Name *
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Target Exam *
Type of Course for Enrollment *
Class Studying *
Name of School Presently Studying *
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Class 12th Academic Performance PCM/PCB (if applicable)
Class 10th Academic Performance PCM/PCB (if applicable)
Permanent Address
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Address of Correspondence with Pin Code and Contact No (where study material will be delivered) *
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Declaration - I/We undersigned, hereby assure that the information given in the application form (as well as in all relevant documents i.e. Cheques, Demand Drafts etc.) is true and correct. I/We have understood and agreed that my misrepresentation or concealment of facts will justify the denial/cancellation of undesired student’s admission, or expulsion from the institute at any stage of the academic session. I have read and hereby provide my/our free consent to the terms and conditions of application form and mentioned on the website for admission in the institute for the academic session 2017-18 further, if undersigned is admitted I/We promise to abide by all the rules and regulations and norms of discipline of the institute as long as undersigned student remains a registered student of Kshitij Education India. I/We hereby also declare that while being an enrolled student of Kshitij Education India, undersigned student will be responsible in terms of providing relevant details of all the competitive examination (in form of true photocopies of the application form of the relevant examination) while he/she will be appearing in the future by virtue of coaching and academic support from the institute. If the undersigned student, as registered student succeeds in any of these competitive examination, Kshitij Education India will have all the rights of using his/her result, photo graph and testimonials in any form for its growth strategies and development plans. In such cases I/We never have any objection or protest for this. *
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