IAS, 2014

For Office Use only

12, Masilamani Street, T. Nagar, Chennai 600 017.

Student No: C

4 Affix Passport Size Photo here 4.5 4.5 cms Enclose two additional signed photographs with this Form (Enrolment forms will not be accepted without three photographs)

ENROLMENT FORM POSTAL SUPPORT PROGRAMME FOR

CIVIL SERVICES EXAM, 2014

The Principal, BRILLIANT TUTORIALS PVT. LTD. Sir, Have you previously enrolled in any BT Course? Yes No
If Yes, Course ......
PLEASE ENSURE THAT THIS IS THE COURSE YOU WISH TO APPLY AND ENROL FOR. PLEASE COMPLETE AND SIGN BOTH SIDES OF THIS FORM.

Enrolment No.

Please enrol me as a student of your 18 Month Stream commencing April 13 15 Month Stream commencing July 13 12 Month Stream commencing October 13 9 Month Stream commencing January 14 Fee: Rs. 22,428/- + Service Tax Rs. 2772/-. Total Rs. 25,200/I herewith remit the full course fee of Rs.25,200 by MO/DD drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai. MO Receipt / DD No. Bank Date Net Banking/Credit Card/Online Bank Transfer ___ (Bank routing instructions given below) Transaction Confirmation No. Date Credit Card Authorization Code Cash/ Credit Card at your Centre in
(See Prospectus for list of Centres) Visa Master Card

REFERENCE NUMBER:

......

Last 4 Digits of Card No. Yes No

*I would like to receive all updates and/or promotional materials as text messages on my cell phone number given above (Please

the appropriate boxes)

I understand that if I change my Optionals in the first or successive attempt, additional charges will be paid as per the terms of the course given in the Online / Hardcopy Prospectus. I have read and shall abide by the rules and regulations for this Course given in the Online/Hardcopy Prospectus. Fees once paid will not be refunded or adjusted under any circumstances. All matters are subject to the exclusive jurisdiction of courts in Chennai only. BANK ROUTING DETAILS Yours faithfully, Pay to: BRILLIANT TUTORIALS PVT LTD. Signature of Applicant: Date:
(PLEASE PRINT IN BLOCK LETTERS) Account No. 014010200034654 Bank, Branch: AXIS BANK LTD, T.NAGAR BRANCH, CHENNAI 600 017. IFSC Code For NEFT: UTIB0000014 Note: Payment by NEFT only. Bank charges to be paid by student.

Applicants Name (as in school records)....: Date of Birth : Date Month Year Sex: Male Female Category to which you belong : General/SC/ST/OBC/Defence Educational Qualification : Year of Graduation .... Institution .... Subjects of specialisation .... Permanent Home Address: Telephone: STD Code: Own PP Fax: Number: E-Mail: * Cell Phone: * PIN CODE:

Name and Address to which all Correspondence and study material should be despatched: Telephone: STD Code: Number: Own PP Fax: E-Mail: *

Cell Phone: * PIN CODE:

Our course material is in the English Medium only Fees once paid will not be refunded or adjusted under any circumstances. No instalment facility. Enrolment will not be accepted without the photograph/s. Personal Cheques will not be accepted. Your application for admission will not be accepted unless your address is complete with Pin Code. *Denotes mandatory fields. Brilliant Tutorials reserves the right to use the photographs and/ or testimonials from the student in promotional / publicity material. REMEMBER TO SEND TWO ADDITIONAL, SIGNED PHOTOGRAPHS (PREFERABLY COLOUR) WITH THIS FORM. Please keep a copy of this application for your records

CIVIL SERVICES EXAM, 2014

MAIN EXAM OPTIONALS
Note: Please read the guidelines given in the Prospectus for choosing the optional. This is an important decision for success

(CHOOSE 1) (PLEASE SEE NOTE BELOW)

Anthropology Chemistry Commerce & Accountancy Electrical Engg. Management Mechanical Engg Physics Psychology Sociology Economics Geography History Mathematics Public Administration Political Science and International Relations Zoology

(Please

the appropriate boxes)

I understand that (i) You do NOT offer material for Indian Language (Paper I of Main Exam)

I agree to inform BRILLIANT TUTORIALS of my Prelim Test Roll Number as soon as I receive my Hall Ticket from UPSC and shall also inform you of my ranking as soon as the final results are published.

Date:

SIGNATURE OF STUDENT