GATE, 2010

For Office Use onlys

E G
12, Masilamani Street, T. Nagar, Chennai – 600 017. Student No: 1 0

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ENROLMENT FORM Enclose two signed
SUPPORT PROGRAMME FOR photographs with this
Form
GATE, 2010
PLEASE ENSURE THAT THIS IS THE COURSE (Enrolment Forms
The Principal, YOU WISH TO APPLY AND ENROL FOR. will not be accepted
BRILLIANT TUTORIALS PVT. LTD. COMPLETE AND SIGN BOTH SIDES OF THIS without three
FORM. photographs)
Sir,
I have passed/will pass …………………………………… in …………………………
(Name of Course) (Month/year)
from …………………………………………………………… (Name of Institution and Place)
Discipline (Major Subject) ………………
Have you previously enrolled in any BT Course? Yes No
If Yes, Course …………………….,,………………...……
Enrolment No.
REFERENCE NUMBER: B T ………...………………………..

Please enrol me as a student of your Support Programme for GATE 2010:

Postal Course with Test Series
Postal Course only
Test Series only
I herewith remit the full course fee of Rs. /- by:
MO/DD drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai.

MO Receipt / DD No. Bank Date

Online Bank Transfer/ Credit Card Visa Master Card
(Bank routing instructions given below) Transaction Confirmation No. Date
Cash/ Credit/Debit Card at your Centre in Credit/Debit Card Authorization Code
Last 4 Digits of Card No.
(Please 3 the appropriate boxes)
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. BANK ROUTING DETAILS
Pay to: Brilliant Tutorials Pvt Ltd.
Yours faithfully,
Account No. 014010200034654
Account Branch AXIS BANK LTD, T.NAGAR, CHENNAI – 600 017.
IFSC Code For RTGS: UTIB0000014
Signature of Applicant IFSC Code For NEFT: UTIB0000248
Date: Note: Bank charges to be paid by student
(PLEASE PRINT IN BLOCK LETTERS)
Applicant’s Name (as in school records)..…...........……:
Date of Birth : Date …………… Month ……………… Year …………… Sex: Male Female

Permanent Home Address:

Telephone: STD Code: Number:

Own PP

Fax: E-Mail: * PIN CODE:

Name and Address to which all Correspondence

and study material should be despatched:

Telephone: STD Code: Number:

Own PP
Fax: E-Mail: * PIN CODE:
Our course material is in the English Medium only • Fee once paid will not be refunded or adjusted under any circumstances. • No instalment
facility. • Enrolment will not be accepted without the photograph/s. • PIN CODE, AN ABSOLUTE MUST. • Your application for admission
will not be accepted unless your address is complete with Pin Code. *E-mail mandatory
REMEMBER TO SEND TWO ADDITIONAL SIGNED COLOR PHOTOGRAPHS WITH THIS FORM.
Please keep a copy of this enrolment form for your records
 GATE 2010
STUDY MATERIAL ONLY

INSTRUMENTATION ENGINEERING (IN) Rs. 12,497/-

(Fee: Rs.11,330/- + Service Tax Rs. 1167/-)

MATHEMATICS (MA)

PHYSICS (PH) Rs. 8570/- each

(Fee: Rs. 7770/- + Service Tax Rs. 800/-)
CHEMISTRY (CY)

ENGINEERING MATHEMATICS (A) Rs. 4831/-

(COMPULSORY FOR ENGINEERING SCIENCES) (Fee: Rs.4380/- + Service Tax Rs. 451/-)

OR
LIFE SCIENCES (XL)
a. Compulsory Subject with two Optionals : Rs. 9,916/- (Fee: Rs. 8990/- + Service tax Rs. 926/-)
b. Compulsory Subject with one Optional : Rs. 7920/- (Fee: Rs. 7180/- + Service tax Rs. 740/-)
c. Two Optionals without Compulsory : Rs. 7125/- (Fee: Rs. 6460/- + Service tax Rs. 665/-)
d. One Optional without Compulsory : Rs. 3530/- (Fee: Rs. 3200/- + Service tax Rs. 330/-)
e. Compulsory Subject only : Rs. 4831/- (Fee: Rs. 4380/- + Service tax Rs. 451--)
STUDY MATERIAL WITH (OPTIONAL) TEST SERIES

Engineering Subjects (Choose one)

Mechanical Engineering (ME) Computer Science & Info. Technology (CS)
Electrical Engineering (EE) Production and Industrial Engineering (PI)
Electronics and Communication Engineering (EC)

Fees:
Study Material only : Rs.12,497/- (Fee: Rs.11,330/- + Service Tax Rs.1167/-)
Study Material + TS9 : Rs.14,813/- (Fee: Rs.13,430/- + Service Tax Rs.1383/-)
Study Material + TS5 : Rs.14,189/- (Fee: Rs.12,864/- + Service Tax Rs.1325/-)
TS9 Test Series only : Rs.2316/- (Fee: Rs.2100/- + Service Tax Rs.216/-)
TS5 Test Series only : Rs.1692/- (Fee: Rs.1534/- + Service Tax Rs.158/-)

LIFE SCIENCES (XL) Please 3 all the options you would like to take.
Chemistry CHOOSE A MAXIMUM OF ANY TWO SUBJECTS
LIFE SCIENCES (XL) (Compulsory)
(H) Biochemistry (I) Biotechnology (J) Microbiology (L)

Study Material only

Study Material + TS9 Test Series

Study Material + TS5 Test Series

TS9 Test Series only

TS5 Test Series only

Fees:
Study material only : See above
Chemistry (Compulsory) + TS9 : Rs.7147/- (Fee: Rs.6480/- + Service tax Rs.667/-)
Chemistry (Compulsory) + TS5 : Rs.6523/- (Fee: Rs.5914/- + Service tax Rs.609/-)
Study material + TS9 : Rs.5868/- (Fee: Rs.5320/- + Service tax Rs.548/-) each
Biochemistry / Microbiology / Biotechnology
Study material + TS5 : Rs.5244/- (Fee: Rs.4754/- + Service tax Rs.490/-) each
Biochemistry / Microbiology / Biotechnology

Add: Additional Test Series Chosen: For EACH Optional TS9: Rs.2316/- TS5: Rs.1692/-

TOTAL FEES (for XL option): Rs. /-

Student’s Signature: Date :