CUET (UG) A DMISSION FORM
Please affix the
1st passport size colour
Admission Date: / / photograph of the
student here
Registration Number (Student unique identification) :
Study Mode (Regular/Weekend/Online) :
Program Name (Lakshya/other) :
Duration of Program :
Scholarship Awarded % (if applicable) :
Student’s Name (in Block Letters) :
Date of Birth : / / E-mail ID :
Mailing Address :
Pin :
Contact No (Mobile) : Land Line (with STD Code) :
Permanent Address (if any) :
Pin :
Contact No. (Mobile) : Land Line (with STD Code) :
School/College Last Attended / Presently Attending :
Address :
Pin :
(a) Father‘s Name : Qualification :
Occupation : Business □ Govt. Service □ Pvt. Service □ Others (please specify) :
Name of the Company / Office :
Nature of Business / Job : Designation :
Department : Contact No (office) :
Office / Business Address :
Pin :
E-Mail ID : Mobile No :
(b) Mother‘s Name : Qualification :
Occupation : Business □ Govt. Service □ Pvt. Service □ Others (please specify) :
Name of the Company / Office :
Nature of Business / Job : Designation :
Department : Contact No (office) :
Office / Business Address :
Pin :
E-Mail ID : Mobile No :
1
(c) Details of the Sibling(s) (if applicable)
Name :
Class studying in : Enrolment No. (if enrolled with TCA) :
(please refer course fee Structure)
Payment details (For OFFICE USE ONLY)
Mode of Payment Fee
S. No. Installment Dated GST Total Amount
(Cash / Bank Transfer / UPI /Cheque) Amount
Total
Received by: ______________________ Received on Date: _______________________
DECLARATIONS / UNDERTAKINGS
Kindly do not take admission at TCA, if the following declarations are not agreeable to you
Please read the Declarations / Undertakings carefully before signing
be obtained from the institute against the payment
Declaration:
of price determined the institute.
1. It is compulsory/mandatory to provide e-mail ID
/ Mobile No. of the student / father / guardian. 4. Students are not allowed to carry mobile phone / I-
The result of tests or any other information by pod in the class rooms. However, if he/she carries
the Institute will be sent to the student & parents mobile phone in the classes, then it should be
WhatsApp group. If he/she has not given his/her switched off. The Institute is not responsible for any
e-mail ID /mobile no. in the Admission Test form loss / theft of mobile phone or valuables or cash in
at the time of admission Institute shall not be the Institute.
responsible for correspondence 5. Each student will be provided Bag. The entry in to the
2. In case, if the teachers feel that the student is class rooms/Institute will be only with bag.
not working hard, indiscipline, disturbing, 6. The parents can enquire about the progress or any
irregular in attendance, not responding properly other problems concerning their wards from the
then he/she may be expelled from the Institute. institute. They can also meet the in charge with the
The decision of the in charge in this regard will prior appointment. Time to time the institute will
be final and binding on the student. No fee or also send the progress report to parents. If the
part of the fee will be refunded in such cases. installment is not paid within stipulated time a
3. If the study material or any accessories provided further grace period of only 10 days will be given,
to the student is lost/misplaced, a new one can after admission will be considered automatically
cancelled and no claim will be entertained.
Student’s Signature Signature of Father / Mother / Legal Guardian
Name : Name :
Date : Date :
Place : Place :
Signature of the Account / Admission Coordinator
Toppers Cos Academy Pvt. Ltd.
Date: Place:
