+2 Register No.

Admission Quota ---Select Quota--- Management NRI

Course ---Select Course--- B Pharm Pharm D

College Name

Applicant Name

Applicant Photo

Applicant Signature

Gender ---Select Gender--- Male Female Other

Date of Birth

Age as on 31-12-2025

Religion

Community

Annual Income

Mobile No.

Email Invalid email format

Father Name

Mother Name

Permanent Address Same as Permanent Address

Communication Address

H.S.E or Equivalent, specify

Board of Public Examinations

Month, Year of passing

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

Transaction ID.

Transaction Date

Bank Name

 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 certificates at the time of admission. I carefully and thoroughly read the Prospectus, I am ready to abide the terms and conditions mentioned in the Prospectus.