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PARENT / GUARDIAN DETAILS
Course Preferred
BACHELOR OF PHARMACY (B.PHARM)
DIPLOMA IN PHARMACY (D.PHARM)
Quota
MANAGEMENT
Admission sought for the Year
AY 2024-2025
PERSONAL DETAILS
Name of Student *
Gender *
MALE
FEMALE
Date Of Birth *
Phone *
Email *
Religion & Community *
HINDU
MUSLIM
CHRISTIAN
Category *
Reservation/Other Benefits *
City *
Pincode *
State *
Nationality *
Address For Corrspondance *
Photo *
Dimensions of which cannot exceed 600w*800h
PARENT / GUARDIAN DETAILS
Name of Father *
Occupation *
Mobile No1. *
Mobile No2.
Email
Name of Mother *
Permanent Address *
ACADEMIC DETAILS
Name of Examination *
Register/Roll Number *
Year of Passing *
Grade / Mark Percentage *
Name of the Institution *
Name of the Board/University *
Marks obtained in the Qualifying Examination
PHYSICS
Marks Secured:
Maximum Marks:
Percentage:
No. of Chances:
CHEMISTRY
Marks Secured:
Maximum Marks:
Percentage:
No. of Chances:
MATHEMATICS
Marks Secured:
Maximum Marks:
Percentage:
No. of Chances:
BIOLOGY
Marks Secured:
Maximum Marks:
Percentage:
No. of Chances:
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