Application for Admission To M.Pharm / Pharm.D (P.B) | 2024-25

Course applied for *
(Each application shall be used for one course only)

Upload Your Passport Size Photo *
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M. Pharm Specialization Applied*

Admission Quota*

Name of the College*

Name in Block Letters*

Sex*

Male

Female

Other

Date of Birth*

Age as on 31-12-2024*

Name of Father*

Name of Mother*

Religion & Community*

Permanent Address*

Address for Communication*

Phone Number*

Mobile No*

Email Address *

Annual Income of the Family

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

Details of B.Pharm Examination Passed

Name of the college where you have undergone B.Pharm*

The PCI approval details of the college*

Name of the University*

No. of chances taken for the qualifying exam.*

Marks Obtained - Yearly Pattern

For those who undergone B. Pharm in Yearly Pattern

Year	Theory		Practical		Grand Total
	Maximum Marks	Marks Secured	Maximum Marks	Marks Secured	Maximum Marks	Marks Secured

1st Year
2^nd Year
3^rd Year
4^th Year
Total :

Marks Obtained - Semester Pattern

For those who undergone B. Pharm in Semester Pattern

Semester	Theory		Practical		Grand Total
	Maximum Marks	Marks Secured	Maximum Marks	Marks Secured	Maximum Marks	Marks Secured

1^st Semester
2^nd Semester
3^rd Semester
4^th Semester
5^th Semester
6^th Semester
7^th Semester
8^th Semester
Total :

Details of GPAT Exam attended (The Score Card compulsorily submitted)

Year of Examination

Score

Online Payment Details

Transaction ID*

Date

Bank/UPI*

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.

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Signature of the Candidate