Online Registration Form

Personal Details

Preferred Title:*

Mr

Mrs

Ms

Miss

Other

Name*

Surname*

Student Image* (image size less than 2 MB)

Date of Birth*

Gender*

Male

Female

other

Nationality:*

Domicile: (i.e. place of permanent residence)*

Mobile No:*

Whatsapp No:*

Email:*

Marital Status:*

Single

Married

Address

Permanent Address:*

City*

Pincode*

if permanent address as correspondence address are same

Correspondence Address: (if different from permanent address)*

City:*

Pincode:*

Course Details

University / College / Country / State Preferred:*

Intake:

Year:

Fees Information: Who Will Pay Your Fees or Who Is your Sponsor?

Please provide evidence of finance, if available*

You

Education Loan

Parents

Guardian

Proof of Identity

Verification of Identity

Aadhaar No:

Passport No:

Expiry Date:

Driving Licence No:

Expiry Date:

Other:

No:

Expiry Date:

Academic Qualifications

Completion Date (mm/yy):

Institution (Including country of study):

Qualification Level:

Grade/Result:

English Language Qualification (If Any)

Title of qualification:

CEFR Level (e.g. B1, B2, C1):

Grade (Including Scores):

Verification Id:

Date:

Emergency Contact No. #1

Name:

Email Id:

Address:

Pincode

Mobile No:

Relation With Applicant:

Emergency Contact No. #2

Name:

Email Id:

Address:

Pincode

Mobile No:

Relation With Applicant:

How Did You Know About Us?*

Website

Agent

Family/Friends

Social Media

Other

Please provide furter details:

Do you have any unspent criminal convictions?*

Yes

No

A criminal record will not necessarily be a bar to obtaining a place at the college.

A satisfactory Disclosure and Barring Service (DBS) report will be for successful applicants to enrol in courses where students work with children or vulnerable adults.

Applicants who have a previous conviction will not be automatically excluded from the application process. However, if you have ticked Yes, please disclose details of your offence and conviction, including dates and courts convicted at. This information should be submitted along with your application form in a separate sealed envelope, clearly marked confidential with your name and date of birth on it. Any information disclosed will be handled and disposed of securely by Amicis Study Overseas Kota in compliance with the Criminal Records Bureau Code of Practice, the Data Protection Act and other relevant legislation.

If you are convicted of a relevant criminal offence after your application has been submitted, you must notify us. The College may request further disclosure from you and your offence may affect your application.

DECLARATION

I certify, to the best of my knowledge, the information I have provided is accurate and true. Please note, if any information is withheld or misrepresented, we reserve the right to withdraw your application and/or any admission offer. I confirm that I have read and understand terms and conditions for enrolment to the program.*

Please tick here to confirm if you would like to be contacted by our partners and/or third party organisations about goods and services which we feel may be of interest to you.

Date

Print Name:

Signature of Applicant (Same as passport)* (image size less than 2 MB)