Bhai Jaitajee Foundation India
Plot # 1, Second Floor, Sector 28 –A, Madhya Marg, Chandigarh Paste your latest
Phone: 0172–5040693, 5078995 e-mail: indiabjf@gmail.com passport size
Website:.www.bjfindia.com Whatsapp: +91 82644 62410 photograph here
BJF Repeaters Batch Application Form for NEET
Name of Student: ______________________________________
Father’s Name: __________________________________________ Occupation:________________
Mother’s Name: __________________________________________ Occupation:________________
Residential Address: H.No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Street: ___________________________________________________________________________
Vill & PO:___________________________________________________________________________ Teh. ___________________________________________________________________________
Distt. ___________________________________________________________________________ Pin Code: ___________________________________________________________________________
D.O.B. / _ _ / _ _ / _ _ _ _ _ _ _ _ Category: GEN / OBC / SC Mob. No. ___________________________________________________________________________
Family Income: Rs. _____________________ per month Agri. Land Holding: ____________ Acres
Reference: _________________________ * How did you come to know about BJF ?
Class 10: Board: C.B.S.E./P.S.E.B. School from which passed: ______________________________
Percentage Marks (%) in class 10th: 1. Aggregate: 2. Maths: 3. Science:
Class 12: Board: C.B.S.E./P.S.E.B. School from which passed: ________________________________
Percentage Marks (%) in class 12th:
Aggregate: Physics: Chemistry: Biology:
Number of NEET attempts (if appeared) with year:
Mode of Preparation for NEET (last attempt): Coaching Institute / Self-study/ Tuition Teachers
In case of Coaching, please mention Coaching Institute name:
NEET Roll Number (Last attempt):__________ Rank: _______ (AIR) ________ (Cat. Rank) _______
NEET Marks obtained: Phone/Mobile Number:_____________________
Physics: Chemistry: Biology: Total:
BJF reserves the right to conduct a screening test/interview, if eligible, & decide the eligibility criteria. BJF reserves
the right to cancel the batch if enough suitable candidates are not found.
Student' s Signature _____
__ ______________ Countersigned by Parent _____________________
Please e-mail the filled form to indiabjf@gmail.com or WhatsApp to +91-8264462410 or send by post to “Bhai
Jaitajee Foundation, SGGS Bhawan, Plot # 1, 2nd Floor, Madhya Marg, Sector 28 – A, Chandigarh 160019.
For any inquiry, please call 0172-5078997 between 11 am to 5 pm from Monday to Saturday or email to
indiabjf@gmail.com or WhatsApp to +91-8264462410.
