Application Form

Application for Admission To B.Pharm Lateral Entry 2025-26

Course applied for *
(Each application shall be used for one course only)

Upload Your Passport Size Photo *

Admission Quota*

Name of the College*

Name in Block Letters*

Sex*

Male

Female

Date of Birth*

Age as on 31-12-2025*

Name of Father*

Name of Mother*

Religion & Community*

Permanent Address*

Address for Communication*

Phone Number*

Mobile No*

Email Address *

Details of Qualifying Examination

H.S.E or Equivalent, specify*

University / Board*

D.Pharm Register Number,Year & Month*

Marks Obtained

Subjects	Maximum Marks	Marks Secured	Percentage	No. of Chances
Diploma First Year Marks
Diploma Second Year Marks

Annual Income of the Family

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

Application Fee Details

UPI No*

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Date

Bank*

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

Upload Your Signature *
Name & Signature of the Candidate