Admission form 2019-20

1. Name (Student’s) ………………………………..........................................

2. Rubika India ID No. ……………………………….....................................
3. Application No …………………………………. Programme …………………………....
4. X Standard Score-……………… Year ………. Board- …………………….…..…..
6. XII Standard Score- ……………. Year……….. Board- …………………………….
7. Bachelor Degree--………………. Year ………. Institute/University-………….……
8. Any other Qualification………………………………………………………………………
9. DoB …………………………………………………………………………………………
10. Gender…………………………………..
11. Category*: (Gen/ OBC/ SC/ ST/ Others)…………………………………………….……..
12.Blood Group (Student’s)………………………………………………………………….....
13. NRI (Yes/No)……………………………………………………………………………….
14. Nationality / Citizenship………………………….. Residence Status ……………….……
(Foreign Nationals to mandatorily submit copy of passport, VISA and FRRO Registration)
15. Email (Student’s)……………………………………………………………………………
16. Contact No. (Student’s)……………………………………………………………………..
14. Address (Student’s) - Correspondence
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15. Mother’s Name……………………………………………………………………………..
16. Father’s Name………………………………………………………………………………
17. Mother’s Mail id…………………………………………………………………………….
18. Father’s Mail id……………………………………………………………..………………
19. Mother’s Contact No:………………………………………………………...……………..
20. Father’s Contact No.………………………………………………………………..………
21. Mother (Company’s Name)…………………………………………………….…………..
22. Father (Company’s Name)………………………………….………………………………
CAMPUS PUNE-INDIA, Life Republic, Survey No.74, Marunji,Pune 411057
Email: info@rubikaindia.in Phone: 7770017493 Website: www.rubikaindia.in/www.rubika-edu.com
(A wholly owned Subsidiary of Rubika S.A.S.U, France.)
23. Mother’s Designation……………………………………………………………………….
24. Father’s Designation………………………………………………………………………..
25. Contact No. (Parents/Guardians) …..………………………………………….…………...
26. Email (Parents/Guardians) …………………………...…………………………………….
27. Address (Parents/Guardians)
Permanent Correspondence
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28. Achievements (Academic/Extra Curricular activities) -
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29. Interest / Hobbies –
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24. Scholarship/Fellowship/Studentship awarded by Rubika India, if any.
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25. Fees Concession by Rubika India, if any.
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Date: Signature (Student’s) Signature (Parents/Guardians)

CAMPUS PUNE-INDIA, Life Republic, Survey No.74, Marunji,Pune 411057

Email: info@rubikaindia.in Phone: 7770017493 Website: www.rubikaindia.in/www.rubika-edu.com
(A wholly owned Subsidiary of Rubika S.A.S.U, France.)
 Checklist of Documents
Submitted
Yes No Pending

1. Certificate of Class 10th

2. Transcript of Class 10th

3. Certificate of Class 12th

4. Transcript of Class 12th

5. Transfer Certificate

6. Copy of Passport and VISA*

( mandatory for foreign nationals)

7. Adhar Card/ Any other Photo Id

(for Indian Nationals)

8. 3 Passport size photographs

CAMPUS PUNE-INDIA, Life Republic, Survey No.74, Marunji,Pune 411057

Email: info@rubikaindia.in Phone: 7770017493 Website: www.rubikaindia.in/www.rubika-edu.com
(A wholly owned Subsidiary of Rubika S.A.S.U, France.)