ENROLMENT FORM
 
 
  Mention the year in which you intend to take up
 
  Medical Entrance Examination
 
  I want to take admission in [Please the appropriate box]      
 
 
Comprehensive Correspondence Course for Medical Entrance    
 
 
Repid Revision Series & Question Bank For Medical Entrance    
 
 
Destination Course For Medical Entrance    
 
 
Test Yourself Series For Medical Entrance    
 
 
Very Similar Tests    
       
     
Additional Material on :    
       
Intelligence/Mental Ability
General Knowledge  
       
Gandhian Thought
English  
       
 

SCHOLARSHIP SCHEME
       
  Tick the appropriate box (if applicable) :    
       
40% Concession for 95% and above  
       
30% Concession for 85% and above  
       
       

PERSONAL DETAILS
       
  Student's Name (in block letters)
 
 
       
  Father’s/Guardian’s Name    
 
 
       
 
Date of Birth _______ / _______ / ______ Nationality
 
 
(Day) (Month) (Year)
     
       
 
 
    Address to Which
 
    all Correspondence and
    Study Material
    should be dispatched
     
     
     
 
 
    Permanent Home Address
 
       
       
       
       
       
       
       
       
     
 
 
Phone
 
 
 
Residence
Correspondence
       
 
    Phone (Father/Guardian’s Office)
 
       
 
    E-mail
 
       
       
 
 
 
 
 

ACADEMIC RECORD

    
               
 
Class : XI (Studying) XII (Studying)   XII (Pass)
 
 

Exam

Board/University

Year
of Passing

Percentage of Marks obtained

Science

Physics

Chemistry

Biology

Maths

X

              

XII

              
 
 
 
 
 
  * Attach Photocopies of X / XII Marksheet
       
 

Other Information
 
  Tick the appropriate box    
 
Category GC SC ST Other
       
  Enclose certificate from the competent authority if you belong to Schedule Caste/Tribe
 
 
 

Contact Programme

    
       
 

Please choose one Centre by placing a tick in the appropriate box for the contact programme. This list of centres is tentative and is liable to change. If inadequate number of candidates are not available in a particular centre, the centre is likely to be cancelled.
       
 
Ahmedabad Mumbai Kolkata Chandigarh
       
 
Delhi Hyderabad Kanpur Chennai
       
       
 

Procedure for Enrolment

    
       
 
Enclose either MO Receipt of D.D. drawn on any scheduled bank in favour of “Sachdeva New P.T. College”payable at Delhi. Complete enrolment form should be sent to the Co-ordinator, Correspondence Course Division, Sachdeva New P.T. College, 526, Industrial Estate, Patparganj, Delhi-92.
       
 
 
Name of the Bank/Post Office
 
       
 
Draft / M.O. Number
 
       
 
Date
 
Amount
 
(in figure)
       
       
       
 
 
 

INSTRUCTIONS

    
       
1.

The Enrolment Form is key part of the admission process. Complete, careful and accurate answers to the question are, therefore, extremely important. In case of incomplete or false information the candidature is liable to be cancelled. Admission granted on the basis of false information will be ipso-facto, null and void.
 
 
       
2.

Fill in the Form and forward it to, The Co-ordinator, Correspondence Course Division, Sachdeva New P.T. College, 526, Industrial Estate, Patparganj, Delhi-92, alongwith the remittance. No fee for toppers. Enrolment Form not accompanied with course fee or incomplete form will not be entertained.
 
 
       
3.

The roll numbers and the results should be intimated to the co-ordinator, for compilation of results as soon as possible.
 
       
4.

The student must attend the Personal Contact Programme, when he/she receives the information to that effect.
 
       
5.

The student should set aside some time for the study of notes sent by this institution and study the notes sent to him/her carefully and diligently.
 
       
6.

All Tests should be attempted under simulated examination environment.
       
7.

The material sent from here is our copyright and is meant for the use of student himself/herself only.
 
 

DECLARATION

    
       
 

I hereby apply for admission to Correspondence Course Division of Sachdeva New P.T. College and I declare that
       
 

(i)

 All the information given by me in the Enrolment Form is true and complete to the best of my knowledge and belief.
       
 

(ii)

 I have read the Prospectus and the instructions thoroughly and agree to abide by the requirements, contained therein.
       
 

(iii)

 I will intimate the College my roll numbers for different competitions and my result as and when I receive them.
       
 

(iv)

 The College reserve the right to use my photograph for publication of results.
       
       
 
   
 
  Date Signature of the Student Signature of Father/Guardian
       
     
   
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