:: Brilliant Academy ::

Along with the prospectus, separate Application form is issued to each candidate. Please fill up the
Application form in Block capital letters with students own handwriting.

IMPORTANT THINGS :

	Please see that three photographs are attached. (One pasted & two loose)
	True copy of S.S.C. Mark list.
	Demand Draft should be in favour of Brilliant's Academy.
	It is necessary to pay the full fees at the time of admission.
	Fees once paid will not be refunded under any circumstances.
	Students paying full fees at the time of admission are only eligible for Hostel accommodations
	Kindly note that the students will be allowed to attend the classes only after full payment of fees.

	APPLICATION FORM
	BRILLIANTS ACADEMY, PUNE APPLICATION FOREM FOR

To,

The Principal,

Brilliants Academy pune.

Respected Sir,

1) I am a student of

Xth std :

XIIth Std :

2) Please Enrol me in your

Class room :

Postal Course :

I would like to apply for (Please write in BLOCK LETTERS)

MH-CET		I.I.T-JEE
AFMC-PUNE		CBS's- PMT

Please Tickmark in Appropriate Box

Student Name:

Local Address:

Permanent Address:

Date of Birth:

Mother Tongue:

Parents /Guardian`s Name:

Father`s Occupation

Name of the College/ School

S.S.C Marks %

Year of Passing S.S.C. Exam

Phone No.

S.T.D.Code

Pin Code

Phone No./Mobile NO.

Our Courses is in the English Medium only.

Fee once paid will not be Returned or adjusted under any circumstances.

Enrolment will not be accepted without both photographs.

Attach Xerox copy on S.S.C. mark list.

Your application for admission will not be accepted unless your address
is complete with pincode.

We reserve the right alter the timings / days / venue /.

After the selection of myself either present or in future in I.I.T/ Medical Entrance Exams . Or any other Exam where this coaching is useful,I dont have any objection to publish my Photograph in newspapers or in any media.