Admission

Name

Upload Photo

Father’s Name


Father’s Occupation

Date of Birth

Category

PRESENT ADDRESS

PERMANENT ADDRESS

I want to class period from
to

N.B : * Admission fees of respective course and all payment through D.D/Cheque/Bank A/C in favor of “SARTHAK ACADEMY” Payable at Bhubaneswar.

* All fees should be paid in correct time. Paid fees will not be refunded if the student discontinue form the Training Period. If the student is forded to indulge in immoral activities, He/She will be debarded form the institution.

DECLARAT ION

I hereby declare that all information are true and correct to the best of my knowledge.I have read and understand the rule and regulation (see back side of this form). I agree to abide by the same.

Date

Signature of the Applicant


Notes : Self attested two set of Xerox copies of the following be attached.

(a) School leaving Certificate (b) Adhar card (c) Voter I.D (d) Four Nos. Passport Photograph, Two Nos. Stamp Size Photogrph. (Terms and Condition) P.T.O

·