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.

PAN: AAPFC3913M                                          GSTIN: 32AAPFC3913M1ZB

** 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 Repeaters NEET UG -2027 Live online Batch Nil
ii Repeaters NEET UG -2027 Live online Batch(without study modules)
Nil
iii Live online interactive classes with instant doubt clarification for Regular Tuition cum Entrance Coaching 2025 - 2027
iv Crash Course - 2026
v Live online interactive classes with instant doubt clarification for Regular Tution cum Entrance Coatching 2026
[ * 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.
Captcha Image
Your browser is out of date!
For a better experience,keep your browser up to date.Check here for latest versions.
Google Chrome
Mozilla Firefox
Microsoft Edge
Apple Safari
Opera
UC Browser
×
Top