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Mayank Raj has applied for the STUDY MATERIAL PACKAGE (SMP) course offered by ALLEN Career Institute. He has provided his personal details like name, date of birth, gender, address, contact information, and course details in the application form. He has also declared that he will be responsible for any accidents and agrees to the terms and conditions of ALLEN, including consent for his information to be used for publicity purposes. The completed application form along with required documents should be sent to the Administrator at ALLEN's Corporate Office in Kota, Rajasthan.

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Prachi Kumari
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439 views2 pages

Print Form

Mayank Raj has applied for the STUDY MATERIAL PACKAGE (SMP) course offered by ALLEN Career Institute. He has provided his personal details like name, date of birth, gender, address, contact information, and course details in the application form. He has also declared that he will be responsible for any accidents and agrees to the terms and conditions of ALLEN, including consent for his information to be used for publicity purposes. The completed application form along with required documents should be sent to the Administrator at ALLEN's Corporate Office in Kota, Rajasthan.

Uploaded by

Prachi Kumari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DLP Application Form (Session 2023-24)

Application form 1001131172 Photograph


no:
Name of Applicant: Mayank Raj
Father's Name: Chaturbhuj Kumar Singh
Mother's Name: Jyoti Kumari DOB: 17/10/2006
Gender: Male Medium: English
Stream: JEE (MAIN + ADVANCED)

Course Name / Course Code: STUDY MATERIAL PACKAGE (SMP) / 161105

N.C.-125, Top Floor, Sbi Officers Colony Near Gayatri Mandir, Kankarbagh, Patna - 20
Address: City: Patna ,
District: Patna , State: Bihar , Pin: 800020

Contact Details: Phone No.: - Mobile No: 8210668750


Email: mayankrajops5@gmail.com
Test Center City: Not Defined
CBT Center City: Not Defined
Registration Date & Time: Jul 5 2023 10:18Pm

Fee Details (if fee is pay by DD)


DD No:
Bank Name:
Amount :
Date:
Note:- If fee is Paid by Challan, Please send photocopy of Student Copy of Fee Challan

Declaration
I hereby declare
that I am seeking admission in my ow n interest and accord.
that I shall be fully responsible for any accident / mis-happening occurring w ith me/by me inside / outside the institute's
premises and institute w ill not responsible in any manner.
that I shall be responsible for my rustication on grounds of misconduct, misuse of mobile phones, misuse of internet or any
illegal and indecent activity.
that in case of my selection in Medical / Engineering Entrance Exams / NTSE & Olympiads, the institute reserves the right to use
my name, photo and other information for publicity (Print/ Social media) purpose
that I solemnly affirm that the institute has rights to send me emails (e-new sletters), sms alerts, W hatsApp Messages (Text,
Images, Video, Documents) and post on the mentioned communication details.
that all the information furnished by me in the ONLINE Application Form or in any other form etc. is correct to the best of my
know ledge. I understand that in the event of any information found to be incorrect or false, my admission may be cancelled
w ithout any refund of fee.
that I have read all the instructions of the Information Bulletin / available Online and I do agree to follow the terms & condition
as applicable.
that I agree that no refund is Applicable in DLP Course of ALLEN.
In any unforeseen circumstances, if conduction of exam is not possible at any particular center then exam may not be
rescheduled.
All rights to allocate / relocate the center is reserved w ith ALLEN.
I agree that all dispute are subject to Kota (Rajasthan) jurisdiction only

Send the complete application form along with all required enclosures to the following address:
Administrator (DLP Division)
ALLEN Career Institute Pvt. Ltd.
Corporate Office: SANKALP, CP-6, Indra Vihar, Kota - 324005
Rajasthan, India . Contact No. : 0744-2750275,3510275

-----------------------------------------------------------------------------------------------------------------------------------------------------
Registered & Corporate Office: SANKALP, CP-6, Indra Vihar, Kota (Raj.) – 324005

Note: This is a computer generated document hence no signature required. Print Date:05-07-2023 22:54:21
CIN: - U80100RJ2021PTC077131

Note: This is a computer generated document hence no signature required. Print Date:05-07-2023 22:54:21

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