Admission Form Web Site You can also download the form. click here to download Class you wish to join * D. Pharmacy B. Pharmacy B. Pharmacy Leet M. Pharmacy ( Pharmaceutics ) Full Name * Date of Birth * Age as on 31-12-2021 * Gender * Male Female Residential Address * Pincode * Telephone Father's Name * Father Mobile No * Father's Occupation * Mother's Name * Mother Mobile No Mother Occupation Caste * Category * Nationality * Religion * University Registration No Aadhaar Number * Education Qualification - Matriculation Passing Year University / Board * Roll No Marks Obtained * Total Marks % age Marks * Subject Offered * Educational Qualification 12th Passing Year * University / Board * Roll No * Marks Obtained * Total Marks % age Marks * Subjects Offered * Educational Qualification - B-Pharmacy Passing Year University / Board Roll No Marks Obtained Total Marks % age Marks Subjects Offered Educational Qualification - D-Pharmacy Passing Year University / Board Roll No Marks Obtained Total Marks % Marks Subject Offered Educational Qualification ( Any Others ) Passing Year University / Board Roll No Marks Obtained Total Marks % age Marks Subjects Offered Academic Distinctions / Awards, If any Extra Curricular Activities & Achievements Declaration * Accept I have carefully read the admission eligibility requirements and state that my candidature is liable to be cancelled if found ineligible for admission at any stage. Photograph * Upload Signature *