[go: up one dir, main page]
Scribd
Upload
6 views1 page

Declaration - 17213604 - 3 - 10 - 2017 5 - 37 - 50 PM

The document is an Acknowledgement & Declaration Form for an applicant named Yuganshu Bansal seeking admission for the 2017-18 session at an educational institute. It includes personal details, a declaration of responsibility for actions within and outside the institute, and consent for the use of personal information for publicity. The applicant agrees to abide by the institute's rules and acknowledges the jurisdiction of Kota, Rajasthan for any disputes.

Uploaded by

hritikbansal76
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
6 views1 page

Declaration - 17213604 - 3 - 10 - 2017 5 - 37 - 50 PM

The document is an Acknowledgement & Declaration Form for an applicant named Yuganshu Bansal seeking admission for the 2017-18 session at an educational institute. It includes personal details, a declaration of responsibility for actions within and outside the institute, and consent for the use of personal information for publicity. The applicant agrees to abide by the institute's rules and acknowledges the jurisdiction of Kota, Rajasthan for any disputes.

Uploaded by

hritikbansal76
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
You are on page 1/ 1

Corporate Office:

“SANKALP”, CP-6, Indra Vihar, Kota, (Rajasthan) - 324005


Ph.: +91-744-515-6100
Website: www.allen.ac.in | E-mail: info@allen.ac.in

Acknowledgement & Declaration Form (Session 2017-18 )


Application form no: 17213604 Photograph

Name of Applicant: Yuganshu Bansal


Father's Name: Ashwani Kumar
Mother's Name: Renu Bala
Gender: Male Medium: English
Stream: Jee (Main + Advanced)
Center: CHANDIGARH
Course Name: ENTHUSIAST PHASE-I / 1021
House No.330 ,Sector4-D, Ram Nagar, Sunam
Address: City: Sunam ,
District: Sangrur , State: Punjab , Pin: 148028
Contact Details: Phone No.: - Mobile No: 9876048029
Email: yuganshu1234@gmail.com

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 purpose.
that I solemnly affirm that the institute has rights to send me emails (e-new sletters), sms alerts 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 instructions
as applicable.
that I agree to abide by the Refund Rules of the Institute.
I agree that all dispute are subject to Kota (Rajasthan) jurisdiction only.

Signature of Candidate Date: Signature of Father / Mother

3/10/2017 5:37:50 PM

You might also like