GATE, 2010

12, Masilamani Street, T. Nagar, Chennai 600 017. Student No:

For Office Use onlys E G

0 Affix Passport Size Photo here

ENROLMENT FORM SUPPORT PROGRAMME FOR

GATE, 2010

4.5 4.5 cms Enclose two signed photographs with this Form (Enrolment Forms will not be accepted without three photographs)

The Principal, BRILLIANT TUTORIALS PVT. LTD. Sir,

PLEASE ENSURE THAT THIS IS THE COURSE YOU WISH TO APPLY AND ENROL FOR. COMPLETE AND SIGN BOTH SIDES OF THIS FORM.

I have passed/will pass in (Name of Course) (Month/year) from (Name of Institution and Place) Discipline (Major Subject) Have you previously enrolled in any BT Course? Yes If Yes, Course .,,... Enrolment No. No

REFERENCE NUMBER: Please enrol me as a student of your Support Programme for GATE 2010:

.....

Postal Course with Test Series Postal Course only Test Series only /- by: I herewith remit the full course fee of Rs. MO/DD drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai. MO Receipt / DD No. Online Bank Transfer/ Credit Card
(Bank routing instructions given below)

Bank Transaction Confirmation No.

Date Date
Visa Master Card

Cash/ Credit/Debit Card at your Centre in

(Please the appropriate boxes) I have read and shall abide by the rules and regulations for this Course given in the Online / Hardcopy Prospectus. Fees once paid will not be refunded or adjusted under any circumstances. BANK ROUTING DETAILS All matters are subject to the exclusive jurisdiction of courts in Chennai only. Yours faithfully,

Credit/Debit Card Authorization Code Last 4 Digits of Card No.

Signature of Applicant Date:

(PLEASE PRINT IN BLOCK LETTERS)

Pay to: Brilliant Tutorials Pvt Ltd. Account No. 014010200034654 Account Branch AXIS BANK LTD, T.NAGAR, CHENNAI 600 017. IFSC Code For RTGS: UTIB0000014 IFSC Code For NEFT: UTIB0000248 Note: Bank charges to be paid by student

Applicants Name (as in school records).............: Date of Birth : Date Month Year Permanent Home Address:

Sex:

Male

Female

Telephone: Own Fax:

STD Code: PP

Number:

E-Mail: *

PIN CODE:

Name and Address to which all Correspondence and study material should be despatched: Telephone: Own Fax: STD Code: PP E-Mail: * Number:

PIN CODE:

Our course material is in the English Medium only Fee once paid will not be refunded or adjusted under any circumstances. No instalment facility. Enrolment will not be accepted without the photograph/s. PIN CODE, AN ABSOLUTE MUST. Your application for admission

will not be accepted unless your address is complete with Pin Code. *E-mail mandatory REMEMBER TO SEND TWO ADDITIONAL SIGNED COLOR PHOTOGRAPHS WITH THIS FORM.

Please keep a copy of this enrolment form for your records

GATE 2010
STUDY MATERIAL ONLY
INSTRUMENTATION ENGINEERING (IN) Rs. 12,497/(Fee: Rs.11,330/- + Service Tax Rs. 1167/-)

MATHEMATICS (MA) PHYSICS (PH) CHEMISTRY (CY) ENGINEERING MATHEMATICS (A) (COMPULSORY FOR ENGINEERING SCIENCES) OR Rs. 8570/- each (Fee: Rs. 7770/- + Service Tax Rs. 800/-)

Rs. 4831/(Fee: Rs.4380/- + Service Tax Rs. 451/-)

LIFE SCIENCES (XL) a. b. c. d. e. Compulsory Subject with two Optionals Compulsory Subject with one Optional Two Optionals without Compulsory One Optional without Compulsory Compulsory Subject only : : : : : Rs. 9,916/- (Fee: Rs. 8990/- + Service tax Rs. 926/-) Rs. 7920/- (Fee: Rs. 7180/- + Service tax Rs. 740/-) Rs. 7125/- (Fee: Rs. 6460/- + Service tax Rs. 665/-) Rs. 3530/- (Fee: Rs. 3200/- + Service tax Rs. 330/-) Rs. 4831/- (Fee: Rs. 4380/- + Service tax Rs. 451--)

STUDY MATERIAL WITH (OPTIONAL) TEST SERIES Engineering Subjects (Choose one) Mechanical Engineering (ME) Electrical Engineering (EE) Electronics and Communication Engineering (EC) Fees: Study Material only Study Material + TS9 Study Material + TS5 TS9 Test Series only TS5 Test Series only
LIFE SCIENCES (XL) Please LIFE SCIENCES (XL)

Computer Science & Info. Technology (CS) Production and Industrial Engineering (PI)

: : : : :

Rs.12,497/- (Fee: Rs.11,330/- + Service Tax Rs.1167/-) Rs.14,813/- (Fee: Rs.13,430/- + Service Tax Rs.1383/-) Rs.14,189/- (Fee: Rs.12,864/- + Service Tax Rs.1325/-) Rs.2316/- (Fee: Rs.2100/- + Service Tax Rs.216/-) Rs.1692/- (Fee: Rs.1534/- + Service Tax Rs.158/-) all the options you would like to take.
Chemistry (Compulsory) (H) CHOOSE A MAXIMUM OF ANY TWO SUBJECTS Biochemistry (I) Biotechnology (J) Microbiology (L)

Study Material only Study Material + TS9 Test Series Study Material + TS5 Test Series TS9 Test Series only TS5 Test Series only
Fees:

Study material only Chemistry (Compulsory) + TS9 Chemistry (Compulsory) + TS5 Study material + TS9 Biochemistry / Microbiology / Biotechnology Study material + TS5 Biochemistry / Microbiology / Biotechnology

: : : : :

See above Rs.7147/- (Fee: Rs.6480/- + Service tax Rs.667/-) Rs.6523/- (Fee: Rs.5914/- + Service tax Rs.609/-) Rs.5868/- (Fee: Rs.5320/- + Service tax Rs.548/-) each Rs.5244/- (Fee: Rs.4754/- + Service tax Rs.490/-) each TS9: Rs.2316/TS5: Rs.1692/-

Add: Additional Test Series Chosen: For EACH Optional

TOTAL FEES (for XL option): Rs.

Students Signature:

/Date :