CHAITHANYA CLASSES

IN ASSOCIATION WITH

PROF. P.C. THOMAS CLASSES


Kammath Lane, Sankarayya Road, West Fort, Thrissur - 4.

Phone: +91-7306022990, +91-7306022994, +91-8086767293

Website : www.chaithanyaclasses.com, Email : chaithanyaclasses@gmail.com

PAN: AAPFC3913M                                          GSTIN: 32AAPFC3913M1ZB

APPLICATION FORM FOR ONLINE COURSES FOR NON NRI STUDENTS

Bank A/C details
A/C Name: Chaithanya Classes
A/C No: 0368073000001046
IFSC/NEFT CODE: SIBL0000368
SWIFT CODE: SOININ55
Bank: South Indian Bank, East Fort, Trichur-5, Kerala, INDIA.
** Payments in INR only.
** NB:- While making remittance, Parent or Guardian should mention the student name in the sender to receiver information of the RTGS/NEFT/SWIFT Application.
# NEET JEE/KEAM
i Live online interactive classes with instant doubt clarification for Repeater (2021 Exam)
ii Live online interactive classes with instant doubt clarification cum classroom coaching for Repeater (2021 Exam)
iii Live online interactive classes with instant doubt clarification for Regular Tuition cum Entrance Coaching (2021 Exam)
[Those students who are entering into +2/12th]
iv Live online interactive classes with instant doubt clarification for Entrance only. Sunday Batch (2021 Exam)
[Those students who are entering into +2/12th]
v Live online interactive classes with instant doubt clarification for Regular Tuition cum Entrance Coaching (2022 Exam)
[Students completed class 10th]
vi Live online interactive classes with instant doubt clarification for Entrance only. Sunday Batch (2022 Exam)
[Students completed class 10th]
[ * Sign Indicates Mandatory Fields ]
1 Name*
2 Sex*
3 Year of Exam*
4 Father’s Name*
5 Occupation*
6 Address*
7 Mobile Number of the parent*
Confirm Mobile Number of the parent*
(Re-enter the above mobile number for confirmation.)
8 E-mail Address*
Confirm E-mail Address*
(Re-enter the above email id for confirmation.)
9 Name of the institution last studied / now studying*
10 Class in which now studying / Repeater
(Select which is applicable)*
11 Percentage of Marks/Grade at 10th level*
(Attested copy of the mark list should sent by email.
If not available please mention 'NA')
12 Percentage of Marks/Grade at 12th level*
(Attested copy of the mark list should sent by email.
If not available please mention 'NA')
13 Score in the Entrance Examinations
(For Repeaters only)
Score
14 Languages known English Malayalam Tamil Hindi
15 Hobbies
16 Ambition in life
17 Details of the fee remitted - Payment details
RTGS/NEFT/SWIFT*
Name of the Account Holder*
Amount Remitted*
Name of Bank*
Date of Remittance*
18 Valid ID proof of Student(Adhar, School ID, etc..)*
(Upload jpg | jpeg | png Files.)
19 Upload Passport Size Photo of Student.*
(Upload jpg | jpeg | png Files.)
20 I, the parent/guardian of the student hereby acknowledge that
(a) I have received the Course Programme, I have read it and I have understood all the rules & regulations and my ward will comply with all the rules and regulations mentioned in the Course Programme.
(b) Apart from the live class, my ward will be entitled to view the recordings 3 times. If my ward is found sharing video or login credentials of the account, Chaithanya Classes is free to take any legal action.

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