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Declaration - 1003491153 - 28-11-2024 19 - 31 - 48

The document is an Acknowledgement & Declaration Form for admission to ALLEN Career Institute for the session 2024-25, filled out by an applicant named Ashish Raj. It includes personal details, course information, and a declaration of responsibility regarding conduct and information accuracy. The applicant agrees to the institute's terms and conditions, including communication and jurisdiction clauses.

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17 views1 page

Declaration - 1003491153 - 28-11-2024 19 - 31 - 48

The document is an Acknowledgement & Declaration Form for admission to ALLEN Career Institute for the session 2024-25, filled out by an applicant named Ashish Raj. It includes personal details, course information, and a declaration of responsibility regarding conduct and information accuracy. The applicant agrees to the institute's terms and conditions, including communication and jurisdiction clauses.

Uploaded by

ashishr5412
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ALLEN Career Institute Pvt. Ltd.

Corporate Office:
“SANKALP”, CP-6, Indra Vihar, Kota, (Rajasthan) - 324005
Ph.: +91-744-275-7575
Website: www.allen.ac.in | E-mail: info@allen.in

Acknowledgement & Declaration Form (Session 2024-25 )


Application form no: 1003491153 Photograph

Name of Applicant: Ashish Raj


Father's Name: Raj Kumar
Mother's Name: Ranjana Prashad
Gender: Male Medium: English
Stream: Jee (Main + Advanced)
Center: PATNA, SURYA CRYSTAL
Course Name: NURTURE PHASE-I / 101001
Shivaji Nagar Makhdum Por Bagicha
Address: City: Dinapur ,
District: Patna , State: Bihar , Pin: 800011
Contact Details: Phone No.: - Mobile No: 9934671337
Email: g.b.y.rajkumar7890@gmail.com
Account Creation Date &
Mar 15 2024 8:07PM
Time:
Profile Creation Date &
Mar 15 2024 8:14PM
Time:
Online Application Form
Mar 15 2024 8:18PM
Fee Deposit Date & Time:

Declaration
I hereby declare
that I am seeking admission in my own interest and accord.
that I shall be fully responsible for any accident / mis-happening occurring with me/by me inside / outside the institute's
premises and institute will 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-newsletters), sms alerts, WhatsApp 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
knowledge. I understand that in the event of any information found to be incorrect or false, my admission may be cancelled
without 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.

Registered & Corporate Office : “SANKALP”, CP-6, Indra Vihar, Kota (Rajasthan) - 324005
CIN: - U80100RJ2021PTC077131

Note: This is a computer generated document hence no signature required. Print Date:28-Nov-2024 19:31:48

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