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ELITE CADEMY For office use only.

Roll No.

Receipt No.

Date

Remarks

Mumbai Tel: 7506427336 / 9152839673

ADMISSION FORM ELITE - IES 2021

I wish to enrol in your IES 2021 course. I herewith remit Rs. in favour of Elite Academy,Mumbai in following way.

Bank charges are to be paid by the student.

1. BANK DETAILS 2. BANK DETAILS Account Name ELITE ACADEMY Account No. 35055866067 IFS Code SBIN0012959 Bank Name State Bank of India Branch J.P. Road Branch, Andheri West, Mumbai - 400058 Mumbai - 400058 1. Name in Full : Mr. / Mrs. / Miss (In Block Letters)2. Parent’s / Guardian’s Name : Mr. / Mrs

3. Address : PIN :

4. Contact Telephone - Res No. : Cell No. : Office No. :

5. Date of Birth : 6. Parent’s / Guardian’s Profession :

7. Postal address to which course material is to be despatched:

8. Educational Qualifications : Subject / Branch:

9. E-Mail :

10. College in which you are studying now / last attended

11. Name of Employer

1. Fees can be paid by Online Transfer / NEFT. 2. Alternately you can also deposit the fees in our account in any branch of State Bank of India / Canara Bank by cheque or cash. You can also enrol through SBI Collect.(link given on our Website). 3. In case of online transfer (NEFT) / cash deposit at any bank branches kindly send your Transaction Record printout.

Account Name ELITE ACADEMYAccount No. 2667201000089IFS Code CNRB0002667Bank Name Canara BankBranch SSB, Andheri,

PAYMENT DETAILS Cash Deposit Cheque No.

Cheque Date

Online Transaction ID Bank Name Bank Branch

Place .

Date .

I opt for the following Subject. Please tick ( ) wherever required.

1. Mechanical Engineering 2. Civil Engineering

3. Electrical Engineering 4. Electronics & Telecommunication Engineering

I hereby declare that the above details are true to the best of my knowledge and belief and that I have readthe prospectus thoroughly and agree to abide by the rules and regulations therein

P.S. 1. Payment in cash will be accepted only across the counter.2. Subject to Mumbai Jurisdication.

Signature of the Student

NOTE :

I came to know about Elite Academy from :

Newspaper Magazine

Internet Other Sources

(Specify the name of the Magazine)

(Specify the Website) (Specify the Details)

(Specify the name of the Newspaper)