Date: ENROLMENT FORM

PHOTO

Name & Code of FIITJEE Program Enrolling for (refer Page no.14 in FIITJEE Enrolment Form):

Personal Information
Student Name:
Mobile: Alternate Contact No:
Email Id(in Block Letters):
Student’s Aadhaar No.: Date of Birth:
D D M M Y Y Y Y
Class: VI VII VIII IX X XI XII XII Pass/Appeared
Science + Math/PCM(%): VI % VII % VIII % IX % X% XI % XII %
Marks(if in Grades): X Board - Science Maths XII Board - P C M
Category of Student: General SC ST OBC Other Gender : M F Transgender

Correspondence Address
Address:

City:
State:
Country: Pincode:
Permanent Address
Address:

City:
State:
Country: Pincode

School Information
School Name:

(studying or passed)

City:
State: Pincode
Contact No: Alternate Contact No:
School affiliated to:
Principal Name:
Principal’s Mobile: Principal’s Alternate Contact No:

Parent Information
Father Details
Name:
Email Id(in Block Letters):
Mobile: Alternate Contact No:
Q ualification:
Occupation:
Designation:
Company Name:
Annual Income:

Edfora Infotech Pvt Ltd

2nd Floor, KH No 274, Plot No. 5, Saidulajab Extn., Westend Marg, New Delhi 110030 IN
1 | 5 Pag es
 ENROLMENT FORM

Mother Details
Name:
Email Id(in Block Letters):
Mobile: Alternate Contact No:
Qualification:
Occupation:
Designation:
Company Name:
Annual Income:

Payment Details
Cheque/DD/NEFT in Favor of “Edfora Infotech Private Limited”

Cheque Demand Draft NEFT/IMPS

Cheque/DD/NEFT No.: Issue Date:

D D MM Y Y Y Y

Issuing Bank Name:

Branch Name: Amount :

(inclusive of taxes)
Cheque Demand Draft

Cheque/DD/NEFT No.: Issue Date:

D D MM Y Y Y Y

Issuing Bank Name:

Branch Name: Amount:

(inclusive of taxes)

Target Exam
Class VI: NTSE Fundamentals Jr. Science Olympiad Fundamentals Math Olympiad Fundamentals

Class VII: NTSE Fundamentals Jr. Science Olympiad Fundamentals Math Olympiad Fundamentals

Class VIII: NTSE Fundamentals Jr. Science Olympiad Fundamentals Math Olympiad Fundamentals

Class IX: NTSE JEE (A) Foundation JEE (M) Foundation Jr. Science Olympiad Math Olympiad

Class X: NTSE JEE (A) Foundation JEE (M) Foundation Jr. Science Olympiad Math Olympiad

Class XI: JEE (A) JEE (M) BITSAT Physics Olympiad Chemistry Olympiad Math Olympiad

Class XII: JEE (A) JEE (M) BITSAT Physics Olympiad Chemistry Olympiad Math Olympiad

Class XII (Pass): JEE (A) JEE (M) BITSAT Physics Olympiad Chemistry Olympiad Math Olympiad

I declare that the above mentioned information is complete and true to the best of my knowledge.

Also, I have read and agree to the Terms and Conditions mentioned overleaf.

I hereby agree to the aforesaid Terms & Conditions on my own volition & without any undue influence.
Student’s Signature: Parent’s Signature:

Name: Name:

Date & Place: Date & Place:

Edfora Infotech Pvt Ltd

2nd Floor, KH No 274, Plot No. 5, Saidulajab Extn., Westend Marg, New Delhi 110030 IN 2 | 5 Pages
 Declarations/Undertakings by the Student and Parent/Guardian
The enrolment form once submitted can't be cancelled for any reason. The money paid is non-refundable and non-
transferable
In addition to the above, I understand without any ambiguity that the Product Price once paid is not refundable with no
exception, whatsoever the reason may be, nor is it adjustable towards any other existing or upcoming courses on
Glorifire Platform or towards the Product Price to be paid by any other existing or prospective student
It is understood that this subscription of Glorifire is valid only for the package and the duration for which I am taking
subscription and I/We (the student and the Parents/Guardian) shall not claim/request for subscription to and adjusting
the Product Price to any other package or duration
I/We acknowledge that the subscription provided to the student by EDFORA are the intellectual property of EDFORA and
solely for personal use as an end user and not for commercial use. Further undertake that I shall not store, publish or
make any copy of the content provided by EDFORA in digital or physical format nor shall I provide/give/distribute it to
anyone else
I/We undertake that we shall not indulge in any illegal/un-ethical/unprincipled/immoral/corrupt/dis-honest activities
which may cause loss of property, reputation and goodwill of EDFORA. I/We further undertake to indemnify EDFORA to
compensate for any loss /damages caused to EDFORA
I/We hereby severally and jointly declare unambiguously that I/We have read and understood all the clauses contained
in this Enrolment Form and Declarations and agree to abide by them without any reservation or ambiguity
I/We further undertake to ensure that cheques/drafts including Post-Dated Cheques/eNACH, if any, given by us will be
honored by our bankers. In the event of these cheques/drafts/eNACH being dishonored, EDFORA is at liberty to initiate
any action against us including legal proceedings under section 138 of Negotiable Instruments Act or other appropriate
law
I/We agree & understand that on submission of this enrolment form, I/We have the right to use the product as an end-
user. It is clearly understood without any ambiguity that Glorifire fee is payable irrespective of the use of the product by
the student
I/We know that registered office of EDFORA is situated at New Delhi
I/We understand that in case of any dispute, the jurisdiction will be an appropriate court/forum in Delhi/New Delhi Only
I/We promise to abide by all rules and regulations of EDFORA declaration in true letter and spirit
I/We agree and understand that EDFORA is not responsible for any inconsistency in the system generated user
performance analysis and the actual performance of the same user in the actual target exam
I/We agree and understand that Parents are solely responsible for ensuring no unethical means is used in assessment
by the student to ensure analytics is appropriate reflection of student's standing
I/We agree to abide by the terms and conditions mentioned under "Terms of Use", "Privacy Policy", and "Copyright"
Section published on glorifire.com and acknowledge that I have read and understood the "Disclaimer" published on the
glorifire.com website
In the event of any dispute between the parties regarding the interpretation of clauses of enrolment form or any claim
etc. the matter shall be referred to the Sole Arbitrator appointed by EDFORA. The arbitration proceedings shall be
conducted in accordance with the provisions of the Arbitration & Conciliation Act, 1996 and statutory modification
thereof & rules made there under. The decision of the arbitrator shall be final & binding on both parties. The Venue of
Arbitration shall be Delhi/New Delhi only
The GST has been calculated @18% as per the current prevailing tax rates/laws and is subject to revision with change in
governing GST laws/rules.

I declare that I have retained a photocopy of this document before submitting it to EDFORA.

I hereby agree to the aforesaid terms & conditions on my own volition & without any undue influence.
Student's Signature: Parent's/Guardian's Signature:
Name: Name:
Date and Place: Date and Place:

Edfora Infotech Pvt Ltd

2nd Floor, KH No 274, Plot No. 5, Saidulajab Extn., Westend Marg, New Delhi 110030 IN 3 | 5 Pages
 Terms & Conditions for Post-Dated Cheque(s)/eNACH

I declare that under no circumstances I will be eligible for refund of fees and withdrawal of Post-Dated Cheque(s)/eNACH
issued by me in favor of Edfora Infotech Private Limited for whatsoever reasons
I declare and agree that all Post-Dated Cheques/eNACH issued by me shall be honored and cleared, even if my child/
ward withdraws or otherwise discontinues to use the product for whatsoever reasons
Further I understand that EDFORA shall suffer irreparable losses in case of non-payment of remaining fee of the
installment plan, hence it will be unethical not to honor the Post-Dated Cheque(s)/eNACH. I have opted for installment
fee plan and have submitted the Post-Dated Cheque(s)/eNACH as per the details give below.

I agree that I will make suitable arrangements for the below slated post-dated cheque(s)/eNACH to get honored and will
keep sufficient funds on or before the due date for the same.

Detail(s) of Post dated cheque (Only Local/Payable at par Cheques will be accepted)/eNACH

Product Fee
Total

S.No. C heque No. D ate I ssuing Bank GST

Amount Amount

I further agree to get above Post-Dated Cheque(s)/eNACH cleared, even if my son/daughter/ward discontinues the use of
product for any reasons.

I am signing the above declaration in good mental/physical health and have satisfied myself about EDFORA. The Enrolment
Form was received by me several days before the actual date of signing to enable me to understand the contents of the
same, I have taken legal expert opinion regarding the matters which were not clear to me and I am satisfied.

Student's Signature: Parent's/Guardian's Signature:

(who has issued the cheque(s))
Name: Name:

Date: Date:

Place: Place:

Edfora Infotech Pvt Ltd

2nd Floor, KH No 274, Plot No. 5, Saidulajab Extn., Westend Marg, New Delhi 110030 IN 4 | 5 Pages
 Consequences of Dishonoring of Post-Dated Cheque(s)/eNACH

I understand that non-clearance of any of the Post-Dated Cheque(s)/eNACH, submitted for payment of Glorifire Fee (on
installment basis) as mentioned in this Enrolment Form is punishable under Sec 138 the Negotiable Instrument Act. I
understand that EDFORA shall be entitled to proceed and initiate appropriate legal action against me, to recover the
amount of the Post-Dated Cheque(s)/eNACH along with the legal expenses and out of pocket expenses incurred by
EDFORA.

In case any of my Post-Dated Cheque(s)/eNACH bounces for any reason whatsoever, I undertake to submit a DD/Pay-Order
in favor of "Edfora Infotech Private Limited" payable at New Delhi, within four days of the bouncing of the cheque(s)/eNACH
at my bank, together with Rs. 500/- (Rupees five hundred only) as default money. If the payment of instalment is not made
within 4 days then my son/daughter/ward shall be debarred from using the product without any further notice and I shall
have no claim for refund of fees or any support besides legal action inter-alia action under Section 138 of the Negotiable
Instrument Act may be initiated against me.

Student's Signature: Parent's/Guardian's Signature:

Name: Name:
Date: Date:
Place: Place:

For Office Use only:

Name of the official processing the Form: UDIT SAWHNEY
Employee Code: 35403
Signature:

Payment Acknowledgement
(For Official Use Only)
Name: Place: Email:

Enrolment No: EIPL- 1. Cheque/DD/NEFT No.: Amount

2. Cheque/DD No.: Amount

Accountant

Edfora Infotech Pvt Ltd

2nd Floor, KH No 274, Plot No. 5, Saidulajab Extn., Westend Marg, New Delhi 110030 IN 5 | 5 Pages