Admission Form

Course Applied for*:

Prefered study center*:

Personal Information

Name*:

Father's Name:

Name of Mother:

State of Domicile:

Date of Birth*:

Gender:

Category:

Permanent Address:

Pin:

Phone/Mobile(self):

Email(self):

Phone/Mobile(Father):

Email(Father):

Upload Photo
(3.5 cm X 3.5 cm):


Past Academic Performance in School/Board Examinations:

ClassYear Of Passing OutName of SchoolCityStateBoard%MarksSC+MTHS/PCM/PCB
VII
VIII
IX
X
XI
XII

How did you come to know about Potential Coaching Institute:


DECLARATION BY STUDENT

I hereby declare that the following information given in this application form and other documents is complete and accurate to the best of my/my wards knowledge. I understand and agree to the facts that misrepresentation or omission of the fact will justify the denial/cancellation of my/my wards admission or expulsion from the institute. I have read and do hereby adhere to the terms and conditions provided to me/my ward from the institute during the time of my/my wards admission. Further i promise to abide by the rules and regulations and the norms of discipline of the institute as long as i/my ward remain/remains a registered student of Potential Coaching Institute.

I Accept

Rules and Regulations

1. All rights and reservations come under the sole discretion of the management. The Management may deny admission to any student without assigning any reason for the same.

2. Potential Coaching Institute reserves the rights to cancel the admission of admitted candidates under any of the following circumstances:

a. If the candidate does not join the classes within the stipulated dates even after deposition of the fee.

b. If the fee is not deposited within stipulated date

c. If the candidate fails to furnish proof to the stipulated minimum educational qualification or any other details provided in the admission form.

d. If the candidate is found frequently absent in classes or periodic test or is found using unfair means in periodic test.

3. RIGHTS OF MODIFICATION

The management reserves the rights to modify or alter the structure of any of the courses in order to attain excellence.

4. DISCIPLINARY RIGHTS

In case of any sort of disciplinary offences by the student within or outside the premises will lead to the cancellation of admission.

5. The entire fee amount has to be paid in INR.

6. Any fee paid shall be strictly non-refundable.

7. A fine of 5% on the payable amount of installment will be charged if the fee amount is not paid even after 15 days of the stipulated time.

** The fees paid is entirely non-refundable