PS-ID: ......................................................

Roll No.: ..................................................

Affix your recent

passport size
colour photograph
here.

(To be filled by office only)

To,
The Manager - DLP Division
Aakash IIT-JEE
Aakash Tower, Plot No. 4,
Sector-11, Dwarka,
New Delhi-110075

Admission Form for DLP Courses (JEE)

COURSE APPLIED FOR

Two Years Comprehensive

Study Package (CSP)
for JEE (Main & Advanced) 2017

One Year Comprehensive

Study Package (CSP)
for JEE (Main & Advanced) 2016
XII studying
XII passed

Two Years Comprehensive

Study Package (CSP)
for JEE (Main)-2017

Two Years Comprehensive

Joint Package (CJP)
for JEE (Main & Advanced) 2017

One Year Comprehensive

Joint Package (CJP)
for JEE (Main & Advanced) 2016
XII studying
XII passed

Two Years Comprehensive

Joint Package (CJP)
for JEE (Main)-2017

Two Years Comprehensive

Joint Package Plus (CJP+)
for JEE (Main & Advanced) 2017

One Year Comprehensive

Joint Package Plus (CJP+)
for JEE (Main & Advanced) 2016
XII studying
XII passed

Two Years Comprehensive

Joint Package Plus (CJP+)
for JEE (Main)-2017

One Year Comprehensive

Study Package (CSP)
for JEE (Main)-2016
XII studying

All India Aakash Test Series

XII passed

XII passed

XII passed

for JEE (Main & Advanced)-2016

for JEE (Main)-2016

All India Aakash Test Series

One Year Comprehensive

Joint Package Plus (CJP+)
for JEE (Main)-2016
XII studying

for JEE (Main)-2017

English

Hindi

Mode of AIATS
Online (English)

One Year Comprehensive

Joint Package (CJP)
for JEE (Main)-2016
XII studying

Medium of CSP

Success Achiever

for JEE (Main & Advanced)-2017

Offline (English / Hindi)

Success Magnet

for JEE (Main) - 2017

for JEE (Advanced)-2017

for JEE (Main) - 2016

for JEE (Advanced)-2016

NTSE (Stage-II)Test Series 2015

Online without Books

Online with Books

Offline (with books)

Medium of AIATS (Offline only)

English
Hindi
Centre Name & Code
for AIATS (if Offline):

Roll No. for NTSE Stage-I Qualified Students

Respected Sir,
I want to take admission in your esteemed Institute for the Distance Learning Program Course in Engineering Stream marked ( ) in the box.
I have read the 'Terms & Conditions' of the institute given overleaf and agree to abide by the same. My particulars are given below:
(It is compulsory to fill the form clearly in CAPITAL LETTERS only)

First Name
Last Name

Mothers Name
Occupation of Father / Guardian

Date of Birth*

Male
D

[Please tick

Female

Blood Group

Category
(GEN / OBC / SC / ST / PH)

the relevant box]

Residence Address
(Permanent Address)

Pin Code

(Number with STD Code)

Mobile: (Parents)*

(Number with STD Code)

(Student)

(for SMS)*

Email ID
Correspondence Address
(Please ignore if same as Residence Address)

Pin Code

(Number with STD Code)

(Number with STD Code)

P.T.O.

School / College Name & Address

Student Class category

X appearing

XI appearing

Marks Obtained

% (X Board, Sc. & Maths - Aggregate)

XII appearing

XII passed

% (XII Board, PCM - Aggregate)

Exam Board

(Attach a self-attested Photocopy of Your Original Marksheet)

Eligibility for Scholarship

5%

How did you come to know about Aakash?

10%

15%

Promotions Team

25%
Newspaper

35%
Teachers

[Please tick

Others

[Please tick

the relevant box]

ISC
CBSE
[Please tick

State Board
the relevant box]

[Please tick

Friends/Relatives

Other

the relevant box]

Ex-Aakashians

Website

Radio/TV

the relevant box]

Date:

Sincerely,

Place:

(Signature of the Student)*

FOR OFFICE USE ONLY

Category of Scholarship

Category-A

Category-B

[Please tick

the relevant box]

Cash/Demand Draft No.:

Drawn on:
Office Receipt No.:

Registration No.:
Admission Place:

Date:

Branch

Info. Centre

Promotions Executive

Counsellor (Name):

Receipt Date:
Prov. Receipt No. (if any):

Terms & Conditions

1.

Incomplete Admission Form will be rejected.

2.

It is compulsory to attach self-attested photocopy of mark-sheet of last qualifying Exam.

3.

Students once enrolled in DLP courses cannot claim for refund of fee or part of the fee; if
he/she becomes disinterested during the course due to any reason whatsoever.

4.

It is for the student to see whether he/she is eligible for a certain Engineering Entrance
Examination or not. The Institute does not hold itself responsible if a student's admission
form cannot be forwarded or is rejected by the examination body on any ground whatsoever.
Such a student cannot claim a refund of the whole or any part of the fee he/she has paid to
the Institute.

5.

It is compulsory for a student to attach a recent passport size photograph on the admission
form. The student should also staple three extra photographs with the form. Institute
reserves the right to use the photograph for publicity in case the student secures position /
succeeds in Engg. Entrance Exams.

6.

The responsibility of getting admission form forwarded to the examining body is that of the
student himself/herself or that of the Parents/Guardian.

7.

If the Study material / Content provided to the student is lost/misplaced once delivered at
his/her correspondence address, a duplicate set of despatch can be obtained against the
payment of ` 800 per despatch, through Demand Draft in favour of Aakash IIT-JEE payable
at New Delhi.

8.

Any change of address or phone numbers should be notified to the DLP Division without any
delay through a written application/e-mail: at dlp@aesl.in. If the despatch is returned due to
change of address or any reason whatsoever, ` 500 will be charged for sending the
despatch again.

9.

Fee once paid is not refundable under any circumstances. The fee includes postage / courier
charges and service tax.

Check List: 1.
2.
3.
4.
5.
6.

10. If at any point of time, the Central Govt. further increases service tax, (existing rate of service tax
is 14%) the extra amount of service tax will be borne by the students from the date of
enforcement of the act by the Govt.
11. Students enrolled in Aakash IIT-JEEs DLP Course will have to provide photocopy of Admit Card
of JEE (Main & Advanced) and other Engineering Entrance Exams as soon as they receive their
admit cards from the examining body.
12. Aakash IIT-JEE reserves the right to make any alternation in its program / venue / timing without
any prior notice to anybody. The decision of the Director will be final and binding on the students
and the Parents.
13. In case of any dispute or difference between you and Institute regarding the interpretation of
these terms and conditions, non-payment of any claim or any dispute arising out of or in
pursuant to these terms and conditions, the same shall be referred to sole Arbitrator who shall be
appointed by Chairman of M/s Aakash Educational Services Pvt. Ltd. The proceedings shall be
conducted at New Delhi under the provisions of Arbitration & Conciliation Act and the Courts at
Delhi only shall have the jurisdiction over the matter and/or for enforcement as the case may be.
If an Arbitrator to whom the matter is referred refuses to act or for any reason, does not enter the
reference or after entering into the reference proceedings are abandoned or kept in abeyance or
not proceeded with, it shall be lawful for the Chairman of M/s Aakash Educational Services Pvt.
Ltd. to appoint another person to act as an Arbitrator in the manner aforesaid. Such person shall
be entitled to proceed with reference from the stage at which it was left by his predecessor, if both
the parties consent to this effect, failing which the Arbitrator will be entitled to proceed de novo.
14. The Examination Centre of any place can be changed as per the requirement / need of the
company without any prior notice to the students/parents.
15. If any student fails to receive the study material within 15 days from the date of despatch, kindly
inform the DLP Division telephonically at 011-47623445 /63 or by writing an e-mail at:
dlp@aesl.in.

Four recent Passport Size colour Photographs (latest).

Photocopy of self-attested mark-sheet of last qualifying Exam.
DD in favour of Aakash IIT-JEE payable at New Delhi.
Centre Code and Centre Name on Admission Form should be properly mentioned for AIATS.
If you are an Ex-Aakashian, attach a photocopy of Identity Card issued by Aakash along with the Admission Form to avail concession.
It is compulsory to attach proof of Scholarships along with the Admission Form.

I have read the terms & conditions of AESPL and various policies of the Company as mentioned in the prospectus & promise to abide by the same.

(Signature of the Parent/Guardian)*

* Note : It is mandatory for Student & Parents to sign at the appropriate places failing which admission form will not be processed and will be rejected.

(Signature of the Student)*