Course Enrollment Form

Name Of The Student:
Enrollment ID .:
Batch Date :

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Other Details

Mobile No:
Email Address:
Date Of Birth:
College Name:

Sr.No. Qualification Year Of Passing Percentage/Grade Project Work While Studying

For Professionals only-Work Experience:

Sr.No. Company Duration Designation Responsibilty Handled

Automation Experience (If any):

Automation Hardware
Automation Software

Course Contents Selection

Enter Course Name (VCPGDAE/VCAE/VCAP/VCPP/Other)

Course Duration

The duration of the training program shall be approx. 1 month to 3 Months. (Depending upon selection of course). VIATA reserves the right to change the duration of the training program depending upon participant’s competency level and grasping power.

Course fees and payment schedule

The participant shall strictly follow the payment schedule as given below.

Course Fees : Rs.
Discount Coupon (If any)
Installments Full Payment (Discount Available)

Payment Date Amount(Rs.) Details
Registration (Min. Rs. 1000)
1st Installment (*PDC)
2nd Installment (PDC*)
3rd Installment (PDC*)

*PDC-Post dated Cheque: To submit at the time of course joining.

Terms and Conditions

In case participant fails to adhere to the above payment schedule, VIATA retains the right to cancel his admission for the training program and fees (already paid) will not be refunded. In case the candidate leaves the program for any reason in between, without written permission, despite having enrolled for a number of modules, VIATA will not return the fees already paid by the candidate. Placement service provided by us is Free of cost and will be guaranteed, if student scores more than 70% in final course exam.

I have read and understood above terms and conditions fully. I hereby agree to them in both letter and spirit.

Type the above number: