ADMISSION FORM

G.V.M.COLLEGE OF PHARMACY, SONEPAT (Approved by AICTE, PCI and Affiliated to Pt. B. D. Sharma University of Health Sciences)
Application form for admission to B. PHARMA/LEET against Left out seats 1. Name of the Candidate: (In block letters) 2. Fathers Name: (In block letters) 3. Mothers Name: (In block letters) Date 4. Date of Birth Month Year

Passport size photograph

5. 6. 7.

Nationality: State of Domicile: Present (Mailing Address):

____________________________ _____________________________

________________________________________________________ City ________________ State _______________________________ Pin Code ____________Phone No (With STD Code)_____________ 8. Permanent Address: ____________________________________________ City ________________ State ___________________ Pin Code ____________Phone No (With STD Code)_____________ 9. OLET Pharma Rank No: ____________________

10. Category: GEN/SC/BC/ESM

11. Particulars of Qualification:

Sr. No.

Name of the Examination

Roll no

Year of Passing

Board / University

Maximum Marks

Marks Obtained/ %

I hereby declare that the entries made by me in this application form are true in all respect. I note that my admission to B. Pharm course will be provisional, subject to its approval by Pt. B.D. Sharma University of Health Sciences, Rohtak. I shall abide by the rules of discipline and proper conduct, which may be framed by the university in this regard from time to time. Date: _____________ Place: _____________ (Signature of Applicant) Certified that all the information given above is correct. Date: _____________ Place: _____________ (Signature of Father / Mother /Guardian) FOR OFFICE USE ONLY Form Checked Admission Committee

Date: ___________

Director/Principal