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Student Registration Form Template

This document appears to be a registration form for Kenrise Career Institute. It requests information such as name, date of birth, address, contact details, education history, category, payment details, and declarations. The declarations state that fees will not be refunded if the applicant withdraws, the information provided is true and correct, and the applicant agrees to institute rules and regulations. It also declares that credit for exam success goes solely to Kenrise Career Institute.

Uploaded by

Md Rizwan Ahmad
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
60 views1 page

Student Registration Form Template

This document appears to be a registration form for Kenrise Career Institute. It requests information such as name, date of birth, address, contact details, education history, category, payment details, and declarations. The declarations state that fees will not be refunded if the applicant withdraws, the information provided is true and correct, and the applicant agrees to institute rules and regulations. It also declares that credit for exam success goes solely to Kenrise Career Institute.

Uploaded by

Md Rizwan Ahmad
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

[Link].-03, Plot No.

-2/11, Park View, Sector-17, Nerul (E), Navi Mumbai-400706


Contact No- +91- 9004164029, 7666423201, email- kenrisecareer@[Link] For office use only

Registration form

Course applied for:


Affix latest
............... passport size colour
photograph
(Use capital letters only)

Name:
Date of birth: Blood group: Gender:
Father's name:
Father's occupation: Designation:
Mother's name:
Mother's occupation: Designation:

Address:

City: State: Pin code:


E-mail: Student's mobile no.
Tel. no. with STD code: Parent's mobile no.

Name of school with city where studying presently:

Class in which studying as on date:


Category: General Reserved if reserved please specify.............................
Past academic performance(Last three years):

Class Name of school Year Board Physics% Chemistry% Maths% Biology% Science% Aggr.%

Mention the performance of previous competitive examination, if any:

Payment Details:
DD/Cheque no./Cash Date Amount Bank Name Branch

Declaration: 1. I hereby declare that if I join this institute by paying necessary fee and if I withdraw from the course the institute will not refund any amount.
2. I hereby declare that the information provided by me in the application form are true and correct to the best of my knowledge.
3. My signature below certifies that I have read, understood and agree to the all rules and regulation of the institute.
4. If I get selected in any competitive examinations or secure good marks in board examinations the sole credit goes to
kenrise career institute only.

Place:
Signature (Father/Gardian) with date Signature (applicant) with date

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