APPLICATION FORM

For Office Use Only

Form No. : ............. Date: ....................

Branch : .................................................

HO Address: 401, Sigma Excellence, Opp. Hanuman Temple, Mansi X Road to Vastrapur Lake Road (Ph: 079 4030 1787 / 4032 7045)

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Photograph

Personal Information [use CAPITAL LETTER only]

Date of Birth :(DD/MM/YYYY)

Name:(In Capital Letters)

First Name

Middle/ Father’s Name Surname

Class: Board:

Address for Correspondence

City Pin

Residence Office

Mobile E- MailStudent Mobile for SMS/whatsApp

Name of the School: .............................................................................................................................................................

Subjects: Phy Chem Maths Bio CSc. Eco PE(Opted in School) for Class XI/XII

Courses Applying for

Father’s Name & Occupation(Name of company/ Department with post)

Email:

Mobile:

Mother’s Name & Occupation(Name of company/ Department with post)

Email:

Mobile:

Batch Date & Timing ........................................................................... ........................................................................... ...........................................................................

VIII/IX/X Foundation

Board P C M B CS/Python

Test Series P C M B CS/Python

JEE P C M

NEET P C B

Weekend JEE NEET P (Board) C (Board) M (Board)

Test Series

Test SeriesXI/XII

Math & Science Test Series

JEE Advance (PCM) Crash Cource NEET/JEE JEE Adv Dropper

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DECLARATION OF ACHIEVEMENT (IF ANY)NTSE / OLYMPIAD / KVPY / OTHER ACADEMIC AWARD

FEE REFUND POLICIES

In case once admitted and then a student wants to discontinue any of the courses due to any reason whatsoever, the refund of fee will be made as per under mentioned rules & regulations.1. Once the regular classes are started, the amount of refund will be calculated according to the following rules on total fee amount.2. Till 15 days, whole fee is REFUNDABLE. After 15 days of commencement of classes, 25% of the total fees will be deducted per month for next three months & after three months there will be no refund for fees under any circumstances.3. Number of months for the calculation of fee refund amount will be calculated from the date of commencement of regular class till the date on which refund of the fee is applied for.4. The students/parents should understand that fee refund is a part of institute’s policy and we follow the refund rules & regulations as mentioned above are followed in letter & spirit. However, if the request of refund is submitted (in written with required documents) after the ‘refund dates’ are over, institute may not entertain it. Moreover, refund requests made verbally/orally or through telephone/email shall also not be entertained.

Signature of the Parent/ GuardianDate:

DECLARATION BY THE STUDENT1. I declare that I have read the rules and regulations in the form as mentioned above and fully understood the contents thereby agree to abide by them.2. I declare that all the information furnished in application form is correct to the best of my knowledge. I understand that in the event of any information found to be incorrect or false, my admission may be cancelled without refund of fee.3. I agree to abide by all policies, rules and regulations of the institute as mentioned from time to time.

Date: Signature of the Student

www.keystoneuniverse.com

HO Address: 401, Sigma Excellence, Opp. Hanuman Temple, Mansi X Road to Vastrapur Lake Road 380015 SOBO Branch: 205-208 Aryan Gloria, second Floor, GALA Gymkhana Road, South Bopal 380058

Science City Branch: 101, Shafalya Elegance, Opp. AUDA Water Tank, Science City Road, Sola 380060(Ph: 079 4030 1787 / 4032 7045)

RULES & REGULATIONS

1. Parents/Guardians can enquire about the performance of their ward at any time during the course.2. Students and Parents/Guardians will be solely responsible for student’s absenteeism from the classes.3. The institute will not be responsible for any damage or loss of vehicle.4. Backup classes will be arranged on genuine reason or earlier information by the parents.5. In case of return of cheque, student will be charged INR 300.6. In matters not covered in above rules and regulations, the decision of KEYSTONE shall be final and

7. All disputes are subject to Ahmedabad jurisdiction only.binding to students and parents/guardians.