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Student Admission Form


Admission Notification & Payment Info
First Year Notification
 

Dear Students,

Fill in All Fields in CAPITAL Letters Only.
Course Applied for:*
Course Part / Year Applied for: *
 
1. Personal Information Section
 
Last Name First Name Middle Name
 
a) Name of Student (In case of changed name, type current name)
b) Name of Student as printed on standard 10 Passing Certificate *
c) Father/Husband's Name *
d) Mother's Name *
e) Previous Name of Student (in case of changed name)
f) Reason for Name Change g) Marital Status *
h) Date of Birth (DD/MM/YYYY) *
i) Gender *
j) Place of Birth *
k) Blood Group (with Rh) *
l) Religion *
m) Citizen of (Country Name) *
n) Location *
o) Student's Aadhar Number *
p) Address of Correspondence
(i) State *
(ii) District *
(iii) Tehsil *
(iv) City/Town/Village *
(v) Address (House no., street/area/suburb etc) *
(vi) Pincode *
 
q) Parmanent Address (Type only if differnent than Address of Correspondence)
(i) State (ii) District
(iii) Tehsil (iv) City/Town/Village
(v) Address (House no., street/area/suburb etc)
(vi) Pincode
 
r) Contact Details
(i) Father's Mobile Number
(ii) Mother's Mobile Number #1
(iii) Student's Mobile Number *
(iv) Student's Email ID *
 
2. Legal Reservation Information Section
 
(i) Domicile of State *
(ii) Category *
(iii) if Reserved
(iv) Caste *
(v) Subcaste *
(vi) if Physically Challenged
 
3. Social Reservation Information Section (Check whichever is applicalble, type name if supporting document attached in section 7)
 
a) Ex-Serviceman / Ward of Ex-Serviceman b) Member of Project Affected Family
c) Active-Serviceman / Ward of Active-Serviceman d) Member of Earthquake Affected Family
e) Freedom Fighter / Ward of Freedom Fighter f) Member of Food / Famine Affected Family
g) Ward of Primary Teacher h) Resident of Tribal Area
i) Ward of Secondary Teacher j) Kashmir Migrant
k) Deserted / Divorced / Widowed Women
 
4. Guardian Information Section
 
a) Occupation of Guardian *
b) Annual Income of Guardian (Rs) (Last Financial Year) *
a) Relationship of Guardian with Applient *
b) Phone Number *

Note: If Possible Please Type School / Collage Name in Short Form
Exam Name Board / University School / Collage Passing Date Seat No. Certificate No. Total Marks Out of Is Qualiifying
5. Selected/Opted Papers Section (Write paper codes or paper name only)
Year/Semester: 1/3/5/7 Semester: 2/4/6/8 (if decided in First Semester only))
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
 
6. Attached Documents and Certificates Section
 
Sr.No. Name of Document / Certificate Original / Attested True Copy Attached
1. Passing Certificate of Std 10th Attested True Copy (Mandatory)
2. Passing Certificate of Std 12th / Statement of Marks of Std 12th Attested True Copy
3. Diploma Mark List Attested True Copy (Mandatory)
4. Degree Mark List Attested True Copy
5. Leaving Certificate Original
6. Certificate of Caste with Category Attested True Copy
7. Caste Validity Certificate Attested True Copy
8. Non Creamy Layer Certificate Attested True Copy
9. Affadavit of Changed Name / Marriage Certificate / Govt. Gazette Original
10. Domicile Certificate Attested True Copy
11. Certificate of Physically Challenged Attested True Copy (Mandatory)
12. Aadhar Card Attested True Copy
13.  
14.  
 
7. Other Information Section
 
a) Mother Tongue *
b) Employment Status *
c) Wish to Join i) NCC ii) NSS d) Would You like to apply for Hostel
e) Hobbies, Profeciency and Other Interests *
f) Games and Sports Participation Level
g) Personal Identification Marks

For Help / More Information Contact: 9766242674

Admission Notification & Payment Info
First Year Notification

Address
Post.Box.No. 67,
Survey No. 467/2,
468, Varye,
Tal/Dist - Satara, 415 015

Contacts
Email: info@kbpimsr.ac.in / mba.kbp@gmail.com
Phone: 02162 261 088 / 8421600535

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