Date:.................................. Signature (Student):..

CSIR NET, GATE, IIT JAM, UGC NET, TIFR, JEST, JNU, BHU, ISM, IBPS, NIMCET, SLET, SET, CSAT, CLAT etc.






Which type of course you wish to enrol for? Please tick ()

REGULAR CLASSROOM COURSE CORRESPONDENCE COURSE TEST SERIES OTHERS

YEAR: 2014 2015 2016 2017 | (for NET Students only): June December

EXAM NAME: ___________________________________________ SUBJECT: _____________________________________________

MEDIUM - English Hindi (Hindi Medium material is available in selected courses only)

PERSONAL INFORMATION (All the fields are compulsory; Please fill only in BLOCK LETTERS):

Name of the Candidate: __________________________________________________________ Sex: Male Female

Date of Birth: DD______/MM______/YYYY_________ Fathers Name: _____________________________________________________

Correspondence Address : ___________________________________________________________________________________________

___________________________________________________________________ Alternate Contact No.___________________________

Ph. (Res.) with STD Code: ______________________________________ Mobile No. __________________________________

E-mail ID of the Student: ______________________________________________________________________________________________

Educational Background: ( Please fill aggregate % Marks)
Exam passed Name of school/college
Board of
Education
Year of
passing
% of Marks Rank/Class
X
XII
B.Sc/ B.Tech/ B.A/ B.Com
M.Sc/ M.Tech/ M.A/ M.Com
Other

Course Fee payment details:
Demand Draft(DD) No./ NEFT
No./ Cash Deposit
Drawn on
Bank
Amount

DETAILS PNB HDFC ICICI SBI


VPM CLASSES
A/C No.
4148001800000019 18462560000284 018405500196 32827275775


RTGS/NEFT
IFSC Code
PUNB0414800 HDFC0001846 ICIC0000184 SBIN0030192


Branch Name
PNB, Nagar Nigam
Branch, Kota,
Rajasthan
HDFC, Talwandi
Branch, Kota,
Rajasthan
ICICI,Jhalawar
Road, Kota,
Rajasthan
SBI, Jhalawar
Road, Kota,
Rajasthan

Registration procedure:
Submit your completely signed application form with colour photograph, Demand Draft (DD) drawn in favour of VPM Classes payable at any bank at KOTA,
RAJASTHAN. or Bank Deposit Slip received from the Bank , Qualification Proof (Mark sheet of Post Graduate (PG) or Under Graduate (UG) or College identity Card etc.).
Send all the items to the VPM Classes postal address (mentioned in the top left box of this form) OR E-mail the Scanned copies at info@vpmclasses.com
/vpmclasses@yahoo.com/ query@vpmclasses.com

Note: Fee of any program is not refundable at any stage.
DECLARATION
1. I declare that all the information furnished in this Application Form is correct to the best of my knowledge. I understand that in the event of any information found to
be incorrect or false, my admission may be cancelled without refund of fee.
2. I will provide VPM Classes with the details (Roll Nos. etc) of the entrance exams which I may appear in the future. I shall not withhold this information from VPM
Classes, who are entitled to know the results of their efforts to help me get through the exams. VPM Classes reserves the right to use the photograph for publicity
if I am successful in the Entrance Exams.
3. All legal disputes are subject to jurisdiction of the Courts / Authorities of Kota, Rajasthan only.


Please Affix
Your Recent
Passport Size
Photograph
Address : VPM CLASSES
1-C-8, SFS, Talwandi,
Kota (Rajasthan) -324005
Toll Free: 1800 2000 092
Ph. (0744) 2429714, 09001297111
Website: www.vpmclasses.com
Student Portal : examprep.vpmclasses.com
Email: info@vpmclasses.com
APPLICATION FORM
Registration No.:
(for official use only)