A DMISSION FORM

Admission Date : / /

Please affix the

1st passport size colour
photograph of the
student here
Registration Number (Student unique identification) :

Study Centre :

Program Name (refer page no. 2) :

Program Code (refer page no. 2) :

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 :
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 (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

mportantTERMS & CONDITIONS FOR POST DATED CHEQUE(S) / NACH Mandate

I understand that if my son /daughter / ward withdraws from the Program to which he/she has been admitted
at any point of time or does not attend the Program and thus the seat given to him/her is rendered vacant,
Affix oneself attested
the same will not/cannot be filled up by any other candidate and a vacancy created in the batch due to passport sized
withdrawal of a student after the starting of classes or up to 2 days prior to the same cannot be filled in any photograph of the person
issuing Post Dated
case, therefore I understand that Toppers Cos Academy Pvt. Ltd. shall suffer irreparable losses in case of
Cheque(s) / NACH
non-payment of remaining fee of the instalment plan, hence it will be unethical not to honour the Post Mandate i.e. parents /
Dated Cheque(s) / NACH Mandate. I have opted for instalment fee plan and have submitted the Post guardian

Dated Cheque(s) / NACH Mandate as per the details given below.

I agree that, I will make arrangement, for below stated Post Dated Cheque(s) / NACH Mandate, to get
honoured, and will keep sufficient funds on or before the due date for the same.

Detail(s) of Post Dated Cheques (Only Local / Payable at par cheques will be accepted) / NACH Mandate

S. No. Cheque No. Dated Issuing Bank Fee Amount GST Total Amount

10

11

12

2
I further agree to get above Post Dated Cheque(s) / NACH Mandate cleared, even if, my son / daughter / ward discontinues
studies at TCA, irrespective of any reasons.

I am signing the above declaration in good mental / physical health. I have satisfied myself about Toppers Cos Academy Pvt.
Ltd. The necessary Enrolment-Forms, including this form was received by me several days before the actual date of signing to enable me
to understand the implications of taking admission at Toppers Cos Academy Pvt. Ltd. I have taken expert opinion regarding matters
which were not clear to me and I am satisfied.

In case any of my Post Dated Cheque(s) / NACH Mandate bounces for any reason whatsoever, I undertake to submit a DD/Pay-
Order in favour of “Toppers Cos Academy Pvt. Ltd.” payable at New Delhi, within four days of the bouncing of the Cheque(s) at my
bank, together with Rs. 500/- (Rupees five hundred only) as default money along with late payment of Rs. 50/- (Rupees fifty only)
per day upto 10 (Ten) days from the due date of payment of instalment after which my son / daughter / ward shall be debarred
from classes without any further notice and I shall have no claim for refund of fees or any support in studies besides Legal action inter
alia action under Section 138 of the Negotiable Instrument Act may be initiated against me/us.

Signature of the Student Father / Mother / Legal Guardian’s Signature

{Who has issued the cheque(s)}
Name :
Enrolment Number (for office use only): Name :

Date : Address :

I have retained photocopy of this document for my reference before submitting it at Toppers Cos Academy Pvt. Ltd.

Date : Father / Mother / Legal Guardian’s Signature

Place : Name :

3
 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

Declaration: 12. It is understood that this admission is valid only for the course and the
duration for which I am taking admission and I/We (the student and the
1. I/We hereby declare that the information furnished on this enrolment form
Parents / Legal Guardian) shall not claim / request for admission to and
etc. is correct to the best of my knowledge and belief.
adjusting the fees to any other course or duration.
2. I am taking admission in TCA with the consent of my Father / Mother /
Legal Guardian and after being satisfied in all respects. 13. I/We acknowledge that the course materials provided to the student by
TCA during the course of study at TCA are the intellectual property of
3. I/We undertake that the information / details furnished / given by me/us are TCA and solely for personal purposes and not for commercial use. I
correct and if any discrepancy is found in the said details / information, at
further undertake that I shall not make copies of the study material
any stage of my association with TCA, TCA may take any legal action against
provided by TCA nor shall provide / give / distribute it to anyone else.
me/us which TCA may deem fit including but not limited to my (student)
expulsion from the institute and I/We shall not be entitled for any refund of 14. TCA has enjoyed great relationship with the students and parents.
fees / claim / compensation / damages etc. Almost all students in every class and every program have been succeeding
in coping up with huge pressure of simultaneous preparation for
4. I/We undertake that I/We shall furnish / submit / complete the remaining
competitive exams along with school / board studies. In few cases where
required documents and formalities by at least two days prior to
some students do discontinue because they are not able to cope up with
commencement of course program. However if I fail to do so, TCA may
not allow me to attend the classes, unless otherwise allowed by TCA in simultaneous competitive exam preparations along with school / board
writing. I/We further undertake that I/We shall not claim any refund of studies, the parents have continued to support the good work of TCA.
fees/ cost of study material etc. already paid on ground of inability to What will constitute deficiency in service?
furnish/complete documents / formalities.
If the average feedback of the particular subject teacher goes below 70%
5. I/We understand and acknowledge that TCA does not give any
in the Feedback Form “Annexure - FB” (attached herewith), then the said
guarantee / promise / assurance for success in JEE Main / JEE Advanced /
teacher will be considered to teach below the minimum TCA Standard. If
XII boards, inspite of providing the best teaching faculty and methodology,
a teacher gets less than 70% feedback in two consecutive periods then
due to high-end competition and limited number of seats in IIT. I undertake
his/her teaching will be considered unsatisfactory by high TCA standards.
that I shall not hold TCA responsible if I may not succeed the JEE or
other competitive exam. 15. I/We have fully satisfied ourselves with regards to quality and excellence
of teaching at TCA from all available information / sources and have
6. I/We understand and acknowledge that preparation for JEE requires
decided to study only at TCA. I/We wish to pay the entire fees as per the
exhaustive hard work, extensive study, motivation and self-confidence.
I undertake that I shall follow the rules and teaching methodology beside Fee Plan (Fee Plan I / Fee Plan II / Fee Plan III) option (the
study and practice rigorously without loosing self-confidence. same is signed by me & the student and is attached with this enrolment
form) at our own sweet will and convenience without any pressure /
7. I/We clearly understand that TCA on completion of topics to be covered by
coercion from any one.
TCA in Class XI as per it’s plan, will do goal refocusing for all Two Year
Classroom Program students including PINNACLE program students to 16. I/We agree to submit a photocopy of student’s JEE Main Admit Card & JEE
help each student achieve maximum possible success. This means that Advanced Admit Card at least 10 days before JEE Main & JEE Advanced
some students based on their performance, may have to predominantly exam dates respectively of the concerned JEE year to TCA and admit
focus on exams other than JEE (Main & Advanced). card of various Other Engineering Entrance Exam as soon as I/We receive
the same from the examining body.
8. I undertake that if I leave the institute midway before completing the full
course for any reason whatsoever, including but not limited to transfer 17. I/We fully understand that TCA is giving the scholarship because the
of my Father / Mother / Legal Guardian / ill health of myself or any other student is expected to bring laurels to TCA and will spread good word of
member of the family or my admission in any institute / course / engineering mouth among the students. I/We undertake that I / we shall / will fully
cooperate to achieve this objective including giving photocopy of the
college etc., or my studentship is cancelled because of misconduct etc., I or
student’s JEE Main Admit Card & JEE Advanced Admit Card at least 10 days
my Father / Mother / Legal Guardian shall not be entitled for refund of fees.
before JEE Main & JEE Advanced exam date respectively of the concerned
9. I/We undertake that once I (student) join the study centre / program JEE year and signing the letter of appreciation lauding TCA efforts. I/ We
offered by TCA, I/We shall not be entitled to change the study centre / further undertake that I/We shall attend the seminars / workshops
program nor will I be entitled to refund of fees. However, if TCA finds me / felicitation / interview etc. conducted by TCA after achieving rank by
competent / eligible for the higher course / program, it may consider my the student; however, TCA shall alone bear the entire cost and
expenses in respect thereof. I further undertake to endorse the efforts and
request for change of program subject to payment of difference of
contributions made by TCA In achieving the rank while giving Interviews to
course / program fee.
the media (print / electronic / web). If we fail to give photocopy of JEE
10. In addition to the above, I understand without any ambiguity that the fee Main Admit Card & JEE Advanced Admit Card at least 10 days before JEE
once paid is not refundable at all, whatever the reasons be, nor is it adjustable Main & JEE Advanced exam date respectively of the concerned JEE year,
towards any other existing courses at TCA or any yet to be launched nor TCA will have the right to discontinue the scholarship and/or recover the
towards the fee of any other existing or prospective student. scholarship with interest and the student / parents / legal guardian will have
no objection to the same.
11. I undertake that I shall abide by the rules & regulations of TCA or
18. I/We (student and the parents) declare that TCA will have sole claim
TCA’s associated schools. I undertake that in case of any dispute
over the outstanding academic performance of the student and further
relating to breach / violation of any of the Rules & Regulations of TCA or agree to give a letter of appreciation to TCA for the outstanding result in
TCA’s associated school, the decision of the Management of TCA shall be form of a Letter, a Video Interview or any other forum / format that
final and binding in all circumstances and situations, whatsoever. TCA deems fit.

Student’s Signature Signature of Father / Mother / Legal Guardian

Name : Name :
Date : Date :
Place : Place :

4
 DECLARATIONS / UNDERTAKINGS

As my Father / Mother / Legal Guardian do(es) not reside at __________________________________ and I have no Local
Guardian. I own all responsibility on their / his / her behalf.

Date : Student’s Signature :

Place : Name :

(To be struck off, if Not Applicable)

(Declaration to be given if the Enrolment form is not signed by the Father / Mother / Legal Guardian at the time of admission)

I have received an extra copy of this Enrolment Form, which I shall send to my Father / Mother / Legal Guardian and submit to
TCA within 15 days with his/her signatures. If I fail to do so unless a further relaxation has been given by the TCA authorities in
writing, my admission shall be liable to be cancelled and I or my Father / Mother / Legal Guardian shall have no claim for refund of
fees or any other compensation of any type.

Date : Student’s Signature :

Place : Name :

(To be struck off, if Not Applicable)

Date : Place : Signature of the Account / Admission Coordinator