NIIT________________________________________________________________

Application for Admission

CON.FM.02 : 00

( Please fill in BLOCK letters)

PA. Number
Date

PERSONAL DETAILS

Affix your Passport Size

Photograph here
&
submit one extra copy
along with this form

Name
Address

IC No.

Phone / Mobile

Date of Birth
Gender
M
Email id : _______________________________________________

For Office Use Only

Student Id

Registration Number

Parent/Guardian Name
EDUCATION ( Please start from last qualification. Also give details of computer course(s) done, if any)
Institution
Degree/Diploma
Performance Subject/Area

Place

Receipt Number

Year

Receipt date

WORK EXPERIENCE ( Last job only)

Organisation Name
From

To

Designation

Cash

Nature of Work

Payment Mode
Cheque
Credit

REGISTRATION DETAILS AND CONTRACT TERMS

Admission Type

Program /

City

Centre

Course
Fee Master Code

No. Of Semesters

SOL

Fee Details
S.no

Fee Particulars

Amount payable at the time Of

Admission

Admission Fee

Registration Fee (payable per semester)

Tuition Fees ( Payable in __ instalments per semester )

Total Payable for the

Program /Course

4
5

Admission Status Change Fee *

Total
*
Admission Status Change Fee is payable at the time of change in admission status.
Balance Payments as per payment plan.
Courseware Fee :
In addition to the above fees, courseware fees has to be paid as per prevailing courseware fees.
For Career Series of courses , each semester courseware would be divided into 2 kits.
Fees for each kit is payable, as per payment dates indicated in payment plan, and the prevailing Courseware fees, at that point of time.
Courseware fees payable at the time of Admission is___________________ towards___________ Courseware kit.
STUDENT DECLARATION

I have read the following :

)
)

What NIIT Gives You' Version ______________, I am aware of what NIIT will give me.
Student Hand Book Version ____________________,and have understood the rules for NIIT student, and agree to abide by them .

Batch Code

Start Date

Counsellors Signature & Date

FOC Signature & Date

Days

Time

* Applicants Signature & Date

(* Parent/Guardian to sign for candidates below 18 years)

----------------------------------------------------------------------------------------------C U T H E R E------------------------- ------------------------------------------------------------------------------------------------

NIIT

Application For Admission -Acknowledgment Copy

Registration Number

Student Id

Dear Mr. / Ms ______________________________________

Date : ____________________
We acknowledge with thanks the receipt of Application for Admission from you. The details of your admission are given below. You are required to
make payments as per the payment plan given to you.

Program

City

Centre

Cashier Signature and stamp ______________________________

Batch Code

Start Date

Days

Timings

ENCLOSED PAYMENT DETAILS

PARTICULARS

AMOUNT

CHQ/DD/ No.

CHQ./DD / RECT. DATE DRAWN ON

TOTAL

If applicable:
Discount/Scholarship Details : ________________________
Discount/Scholarship Amount : _________________________
POST-DATED CHEQUE DETAILS

CHQ. NO.

CHQ.DATE AMOUNT

CHQ. NO.

CHQ. DATE AMOUNT

CHQ. NO.

CHQ. DATE AMOUNT

Cashier's Signature & Stamp

< Centre Name and Address>

-------------------------------------------------------------------------------------------C-U-T---H-E-R-E--------------------------------------------TERMS & CONDITIONS

1. Admission to the program is subject to terms & conditions given in the NIIT Student Hand Book.
2. Any upgradation to higher level program/semester will be strictly as per the prevailing fee at the time of upgradation.
3. Cheques/Drafts/Credit Cards are accepted subject to realization.
NOTE : This slip must be brought on the first day of the program for entry into the education centre and for collecting the identity card, invoice and cheque receipt (if any).
<Centre Name and Address>