Application Form | Top pharmacy Colleges in India | top pharmacy college in Dharamapuri

Apply for: *
B. PHARMPHARM. DD. PHARM

Name in Block Letters: *

Sex: *
MaleFemale

Date of Birth: *

Age (As on 1st August): *

Name of Father: *

Name of Mother: *

Religion: *

Community: *

Permanent Address: *

Same as permanent Address

Address for Communication: *

Email ID: *

Phone No: *

Mobile No: *

Qualifying Examination: *

Marks Obtained*

Subjects	Maximum Marks	Marks Secured	Percentage	No. of Chances
Physics
Chemistry
Biology
Mathematics
Computer Science
Biotechnology
Total Marks
Total Marks obtained for both Physics & Chemistry		Percentage obtained for both Physics & Chemistry

Annual Income of the Family: *

If the candidate is claming any reservation or other benefits, furnish details *

Declaration *

I do hereby declare that the particulars given in the application are true to the best of my knowledge and belief. If any of the particulars given by me in this application is proved fraudulent at any later stage of admission, I shall be liable for disciplinary action and my admission shall become null and void. I shall produce the originals of the certificates at the time of interview. I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.

Place:

Name & Signature of the Candidate:

Date:

Name & Signature of Parent or Guardian:

Declaration *

I do hereby declare that the particulars given in the prospectus are carefully read and understood. I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.

Place:

Name & Signature of the Candidate:

Date:

Name & Signature of Parent or Guardian:

Notes: *

Applications received after the prescribed date will not be entertained under any circumstances.
Application forms not supported by relevant documents will not be considered.