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Phone: +91-9457071651 | 8287043699 | 05742-239385, 239485
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Admission Form
B.P.S. Educational Institution of Pharmacy
Admission Sought in
*
D. Pharm
B. Pharm
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Student's Name
*
Middle Name
Last Name
Fathe's/Guardian's Name
*
Middle Name
Last Name
Date of Birth
*
Permanent Address
*
Pin Code
*
1. Mobile No.
*
2. Mobile No.
Email
*
Local Guardian's Name*
*
Guardian's Address*
*
Pin Code
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1. Mobile No.
*
2. Mobile No.
01. Exam Passed.
Exam.
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Select
Class X
Class XII
Year
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Roll No.
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Max. Marks
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Marks Obt.
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Percentage %
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Subjects
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College / University Name
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02. Exam Passed.
Exam.
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Select
Class X
Class XII
Year
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Roll No.
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Max. Marks
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Marks Obt.
*
Percentage %
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Subjects
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College / University Name
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Category
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SC
ST
OBC
MINORIVGEN
PH
Computer knowledge.
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No
Last Educational Institute attended.
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Transport facility required.
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No
Hosted Accommodation Required.
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Extra activity (lf interested than Tick)*
Basket Ball
Volley Ball
Athletics
Hobbies & Interest
List of enclosed certificates (Original & one Xerox Copy)
*
Mark sheet of Secondary Exam.
Mark sheet of Sr. Secondary Exam.
Certificate of Secondary Exam.
Certificate of Sr. Secondary Exam.
Character Certificate.
Transfer Certificate.
Aadhar Card.
Cast Certificate (If any).
Declaration
I have read the rules and regulation of the Institution. I will obey the rules of the Institute and maintain proper discipline. I am not working in any govt. or private organization. I hereby declare that the above information given in correct.
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I declare that above mentioned information is true to best of my knowledge and as Father / Guardian. I will be responsible for my ward's conduct & behaviour and payment of dues & refund in any case.
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