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ENROLMENT FORM

POSTAL SUPPORT PROGRAMME FOR

CIVIL SERVICES EXAM, 2014

The Principal,

BRILLIANT TUTORIALS PVT. LTD.

Sir,

Have you previously enrolled in any BT Course?Yes No

If Yes, Course ......

Enrolment No.

Please enrol me as a student of your

18 Month Stream commencing April 13

15 Month Stream commencing July 13

12 Month Stream commencing October 13

9 Month Stream commencing January 14

Fee: Rs. 22,428/- + Service Tax Rs. 2772/-. Total Rs. 25,200/-

I herewith remit the full course fee of Rs.25,200 by

MO/DD drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai.

MO Receipt / DD No. Bank DateNet Banking/Credit Card/Online Bank Transfer ___

(Bank routing instructions given below) Transaction Confirmation No. DateCash/ Credit Card at your Centre in Credit Card Authorization Code

(See Prospectus for list of Centres)

Last 4 Digits of Card No.

*I would like to receive all updates and/or promotional materials as text messages on my cell phone number given above Yes No(Please the appropriate boxes)

I understand that if I change my Optionals in the first or successive attempt, additional charges will be paid as per the terms of the

course given in the Online / Hardcopy Prospectus.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.All matters are subject to the exclusive jurisdiction of courts in Chennai only.

Yours faithfully,

Signature of Applicant:

Date:

(PLEASE PRINT IN BLOCK LETTERS)

Applicants Name (as in school records)....:

Date of Birth :Date Month Year Sex: Male Female

Category to which you belong : General/SC/ST/OBC/Defence

Educational Qualification : Year of Graduation .... Institution ....Subjects of specialisation ....

Our course material is in the English Medium only Fees once paid will not be refunded or adjusted under any circumstances. No instalment facility. Enrolment will not be accepted without the photograph/s. Personal Cheques will not be accepted. Your application

for admission will not be accepted unless your address is complete with Pin Code. *Denotes mandatory fields.Brilliant Tutorials reserves the right to use the photographs and/ or testimonials from the student in promotional / publicity material .

REMEMBER TO SEND TWO ADDITIONAL, SIGNED PHOTOGRAPHS (PREFERABLY COLOUR) WITH THIS FORM.Please keep a copy of this application for your records

Affix Passport SizePhoto here

4.5 4.5 cmsEnclose two additional

signed photographswith this Form

(Enrolment formswill not be accepted

without threephotographs)

BANK ROUTING DETAILS

Pay to: BRILLIANT TUTORIALS PVT LTD.Account No. 014010200034654

Bank, Branch: AXIS BANK LTD, T.NAGAR BRANCH,

CHENNAI 600 017.

IFSC Code For NEFT: UTIB0000014

Note: Payment by NEFT only. Bank charges to be paid by student.

Name and Address to whichall Correspondence and study materialshould be despatched:

Telephone: STD Code: Number: Cell Phone: *

Own PPFax: E-Mail: * PIN CODE:

Permanent Home Address:

Telephone: STD Code: Number: Cell Phone: *

Own PP

Fax: E-Mail: * PIN CODE:

PLEASE ENSURE THAT THIS IS THE COURSEYOU WISH TO APPLY AND ENROL FOR.

PLEASE COMPLETE AND SIGN BOTH SIDESOF THIS FORM.

12, Masilamani Street, T. Nagar, Chennai 600 017.

For Office Use only

Student No: C S P 1 4

Visa Master Card

3

REFERENCE NUMBER: B T ......

IAS, 2014

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CIVIL SERVICES EXAM, 2014

MAIN EXAM OPTIONALS

Note: Please read the guidelines given in the Prospectus for choosing the optional. This is an important decision for success

(CHOOSE 1) (PLEASE SEE NOTE BELOW)

Anthropology Sociology

Chemistry Economics

Commerce & Accountancy Geography

Electrical Engg. History

Management Mathematics

Mechanical Engg Public Administration

Physics Political Science and International Relations

Psychology Zoology

3(Please the appropriate boxes)

I understand that

(i) You do NOT offer material for Indian Language (Paper I of Main Exam)

I agree to inform BRILLIANT TUTORIALS of my Prelim Test Roll Number as soon as I receive my Hall Ticketfrom UPSC and shall also inform you of my ranking as soon as the final results are published.

Date: SIGNATURE OF STUDENT