Application Form For Admission To Master of Pharmacy (M Pharm) / PHARM. D. (Post Baccalaureate)

First Name * :

Father's/Husband's Name * :

Mother's Name * :

Surname * :

Date of Birth * :

Sex * :

Nationality Status * :

Domicile * :

Candidate's Photo * :

Signature of the candidate * :

E-Mail * :

Mobile No * :

Permanent Address * :

Admission preferred for * :

Preference-1 * :

Preference-2 :

Preference-3 :

Name & address of the College from which candidate has passed * :

District * :

State * :

Name of Parent/Guardian * :

Address of Parent/Guardian * :

Declaration:

a) I hereby declare that the above information is true and complete to the best of my knowledge. I am aware that if any information herein is found to be incorrect or incomplete, my application form will be rejected/admission will be cancelled.
b) If admitted to this Institution I shall abide by its rules and regulations.
c) I have read and understood all the provisions contained in the brochure and hereby agree to abide by these provisions.

Instruction