Application For B-pharm & D-pharm

Name* Email*

Phone No* Date of Birth*

Select Course* -- Select -- B.Pharm D.Pharm

Alternate No: Address*

Pincode District* State*

10th Board Percentage* 12th Board Percentage*

Subject* -- Select -- PCB PCM Others

Specify Subject and marks subject 1* -- Select -- Physics subject 2 -- Select -- Chemistry subject 3 -- Select -- Biology Mathematics Biotechnology Computter Science Others

Marks/100* Marks/100* Marks/100*

Father's Name* Occupation* Annual salary

Phone No* email*

Mother's Name* Occupation* Annual salary

Phone No* email*

Photo* Signature*

10 th Marks Card* 12 th Marks Card*