ADMISSION FORM D. Pharmacy/B. Pharmacy SESSION: 20….

[Pages:2]D K PHARMA COLLEGE

Dhani Thetharbad, Distt -Rewari (Haryana)

ADMISSION FORM D. Pharmacy/B. Pharmacy

SESSION: 20.... ....

Date.......................

Application No. ...................... College Roll No. ...................... Allotted Category......................

Rank......................... Branch......................

Name of Student (In Capital Letter)..........................................................................................

Father's Name..........................................................................................................................

Mother's Name.........................................................................................................................

Date of Birth.............................................................................................................................

Caste.......................... Category.....................

Address....................................................................................................................................

................................................................................................................................................

................................................................................................................................................

Contact No.1............................................. 2) ....................................................................

Father's Occupation ................................................... Annual Income.....................................

Educational Qualifications:-

Examination Passed Board/

Year

Roll No.

Marks obtained / % Marks

University

Max. Marks

Matric

Sr. Secondary

B.A/ B.Sc or Equivalent Exam. Any other examination

Declaration:-

I...................................solemnly declared that all the information's given above are correct to the best of knowledge.

Signature of Parents/Guardians

Signature of Candidate

Attach original copy of the following along with one set of self-attested photocopies

Sr. No.

Document

1

Allotment Letter

2

Character Certificate and a copy of Aadhar number

3

Affidavit from parents of BC candidate (refer Prospectus) (if any)

4

Affidavit in lieu of Gap Year -cum- character certificate for Gap Period for

admission

5

Application Form

Page No.

Attach the attested copies of 2 sets of the following documents only in the order given below

Sr. No.

Document

Page No

1

Matric certificate (for date of birth)

2

Senior Secondary Certificate

3

Graduation or equivalent

4

Post-Graduation or equivalent

5

Haryana Resident certificate (if required)

6

SC/BC Certificate (if required)

7

Differently abled/EWS/Ex-Serviceman/Freedom fighter Certificate (if

required)

8

Anti-Ragging Affidavit from students & parents

Documents checked and verified

Fee Paid (In-charge fee collection) Countersigned by In-charge Admission Committee

Signature of the Teacher (Member Admission Committee)

Provisionally Admitted Signature of Principal (with Seal)

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