PLANET E TUTORS

Application Form
1) Please read the Instructions given overleaf carefully before filling this form. 2) Use blue or black ball pen for filling this form. 3) Tick in the appropriate boxes. 4) Form will be accepted with the demand draft only.

Form No.

1.Course applying for (Tick in the box only) Online Offline Postal 4.Full Name (In CAPITAL letetrs)

2. Course Code 3.Course Name

5.Fathers Name (In CAPITAL letters)

6. Date of Birth
DATE MONTH YEAR

7. Gender Male

Female

8. Academic Information Educational Qualification Maximum Marks Name of Institute Any other qualification

Year of Passing %

9. Email 10. Address: 11.Signature of the candidate 12. Photograph

PIN Code: 13.Telephone No. (with STD Code) 14. Mobile No.

15. Payment Details DD/Cheque Number: Name of the Bank: Date: Amount

INSTRUCTIONS
Fill in the Application Form in your own handwriting, clearly and legibly and in BLOCK LETTERS. Do not overwrite. Wherever choice has to be indicated by putting a tick mark , take care to put the tick marks prominently and within the box Block 1: Course Mode: (AIPG11D) Indicate the course mode which are you applying for Block. 2. Course Code: Indicate whether you are applying for course by filling the course code in the appropriate box. (See the attached paper or see at website.) Block. 3. Course Name : Indicate whether you are applying for course by filling the course name in the appropriate box. (See the attached paper or see at website.) Block 4. Full Name: Write your name in BLOCK LETTERS. Do not write Dr/Miss/Mr. etc. Leave one box blank between two parts of the name. Block 5. Fathers name : Same as above. Block 6. Date of Birth: Please write your date of birth
Block 7. Gender: If Male, tick (v) in the box below MALE. If female, tick (v) in the box below FEMALE.

Block 8.In Academic information provide your correct information details. Block 9: write your email address if any. Block 10: Name and Address: Write your full mailing address within the PIN Code boxes, clearly & legibly, in capital letters and within the space provided Block 11: Put full signatures in the space provided for this purpose. The signatures should be clear Block 12: Affix firmly a recent passport size photograph The photo should be pasted pinned or stapled. Block 13, 14: Write your Telephone number, Mobile No. , if any, within the boxes. Block 15: Write your DD no, DD date and name of the bank clearly.

Declaration
Please read the following Instructions clearly before filling the form. For course code refer the Course Codes page on the website or the page attached with this form Course content and test series prepared will help you only for regular practice and self evaluation of the students preparing for entrance exam. This doesnt ensure that course content prepared will come in your entrance exam. Payment Mode HDFC BANK PLANET E TUTORS, Acc Number : 1872000004584 Please send us an email with relevant information regarding the form, course and course fees Forms without course fees will not be considered. I have understood the rules and regulations of the institute and agree to abide by them. For any additional info log on to www.planetetutors.com or email us at info@planetetutors.com Acknowledgement will be sent only after receipt of Draft/Payment. MOCK TEST DATE & VENUE will be notified soon. Please write your name and address at the back of the Demand Draft Post the completely filled form at Planet e tutors, #19738/10, Ajit Road, Bathinda-151001, Punjab, India.

# 19738/10, Ajit Road,Bathinda-151001 Mob : , 9463337370, 9914042443

Website : www.planetetutors.com E-Mail : info@planetetutors.com