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Registration Form 2023-24
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Registration Form 2023-24
REGISTRATION APPLICATION FORM FOR COURSE
1. Registration Details
*
Mandatory fields
Mode of Admission
*
-Select-
UPSEE/JEE CUP Counseling
Direct/Management
Registration sought for
*
-Select-
B.Pharma
D.Pharma
2. Applicant's Personal Details
Applicant's full name
*
( Full name as per the highest / latest qualification certificate or legal certificate )
Father's Name
*
( Full Name As Per Educational/Legal Certificate )
Mother's Name
*
( Full Name As Per Educational/Legal Certificate )
Gender
*
Male
Female
Date of Birth
*
(dd-Mon-yyyy)
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Month
1
2
3
4
5
6
7
8
9
10
11
12
/
Year
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )
Category
*
--Select One--
General
Other Backward Class
Scheduled Caste
Scheduled Tribe
3. Contact Details
Mobile Number
*
Email Address
Aadhar Card No.
*
4. Address Details
Full Address
*
State
*
--State--
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
National Capital Territory of Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
*
--Select One--
Pin Code
*
5. Qualifying Subjects
Physics Marks
Chemistry Marks
Biology/Math Marks
6. Educational / Qualification Details
S.No.
Qualification
Board/University
Passing Year
Marks
Percentage
1.
High School
*
2.
Intermediate
*
3.
Graduation
Upload Photo
*
( JPG,JPEG,GIF,PNG image with size upto 50 KB )
7. Declaration
I, hereby declare that the particulars submitted by me in the online application form of S.N. College of Pharmacy are true to the best of my knowledge and belief. I agree to abide by the rules and regulations of S.N. College of Pharmacy and also to the decision of S.N. College of Pharmacy regarding any action. I will not held S.N. College of Pharmacy responsible for any damages.
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