D M Pharm

D M PHARM COURSE

APPLICATION FOR ADMISSION TO PHARM.D/ PHARM.D (PB)/M.PHARM COURSE

Application No. (For Office Use Only)

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MERIT/MANAGEMENT

Name of the Candidate (In BLOCK letters as given in SSLC/10th Certificate)

Expansion of Initials (If applicable)

Date Of Birth

Gender

Age

Name of Father

Name of Mother

Occupation and Annual Income

Religion & Caste

Enter the percentage of marks scored in the following examinations

Exam Name

Name of the Board/University

Year of Passing

Month of passing

Medium

Percentage marks. Aggregate

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Exam Name

Name of the Board/University

Year of Passing

Month of passing

Medium

Percentage marks. Aggregate

Enter the marks scored and percentage in Qualifying examination.

Physics (maximum)

Physics (Obtained)

Physics (Percentage)

Chemistry (maximum)

Chemistry (Obtained)

Chemistry (Percentage)

Biology/Botany (maximum)

Biology/Botany (Obtained)

Biology/Botany (Percentage)

Zoology (maximum)

Zoology (Obtained)

Zoology (Percentage)

PCB (maximum)

PCB (Obtained)

PCB (Percentage)

Mathmatics (maximum)

Mathmatics (Obtained)

Mathmatics (Percentage)

English (maximum)

English (Obtained)

English (Percentage)

Second language (maximum)

Second language (Obtained)

Second language (Percentage)

Total (maximum)

Total (Obtained)

Total (Percentage)

B.PHARM

1st year (total max marks)

1st year (total score)

1st year (Percentage)

2nd year (total max marks)

2nd year (total score)

2nd year (Percentage)

3rd year (total max marks)

3rd year (total score)

3rd year (Percentage)

4th year (total max marks)

4th year (total score)

4th year (Percentage)

Aggregate percentage

DECLARATION

I hereby declare that the above information furnished by me in this application and the enclosures are true. I will not indulge in any form of ragging. I know it is a criminal offence and if found guilty, I will be summarily dismissed. I promise to abide by the rules and regulations of the institution.

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I hereby agree to cooperate with the collage to ensure the rules and regulations framed in the interest of my word.

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Documents/Certificates to be attached. *if applicable
1. Original Mark sheets of Qualifying Examination.
2. Pass Certificate*
3. Original Conduct/Character Certificate issued by the institution last studied.
4. Original Pharmacy council Registration Certificate*
5. Copy of certificate in support of the Date of Birth
6. Original Transfer Certificate issued by the institution last studied.
7. Certificate for SC/ST/OBC/OEC*
8. Migration Certificate*
9. Income certificate by competent authority
10. Aadhar Card
11. Five Passport size colored Photographs (Name and Date of Birth affixed) and two stamp size colored Photographs
12. Any other documents (Please specify)...................................

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APPLICATION FOR ADMISSION TO PHARM.D/ PHARM.D (PB)/M.PHARM COURSE

MERIT/MANAGEMENT

Enter the percentage of marks scored in the following examinations

Enter the marks scored and percentage in Qualifying examination.

B.PHARM

DECLARATION

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