Kerala State self financing pharmacy college management association

Cochin College of engineering and technology, Bachelor of pharmacy 2019 - 2020
Application for admission to B. Pharm

Personal Details

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

College Applied*

Name in Block Letters*

Sex*

Date of Birth*

Age as on 31-12-2018*

Name of Father*

Name of Mother*

Religion & Community

Permanent Address*

Address for Communication*

If permanent address same?

Phone No.

Mobile No.*

Details of Qualifying Examination

H.S.E. or Equivalent, specify*

University / Board*

Register Number, Year & Month*

Marks Obtained
Maximum Marks Marks Secured Percentage No. of Chances

Physics*

Chemistry*

Biology

Mathematics

Computer Science

Biotechnology

Total Marks*

 

Annual Income of the Family*

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

DD No, Date*

Bank*

I 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

Place:

Date: 17/11/2019

Name & Signature of the Candidate

Name & Signature of Parent or Guardian

I hereby declare that the particulars given in the prospectus are carefully read and understood. I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.

Place:

Date: 17/11/2019

Name & Signature of the Candidate

Name & Signature of Parent or Guardian

Notes:

1.Duly filled application form along with relevant documents and DD for Rs. 1000/- in favour of Kerala State Self Financing Pharmacy College Management Association Payable at Chalakudy, should be submitted to the office of the college on or before 12-06-2019

2.Applications received after the prescribed date will not be entertained under any circumstances.

3.Application forms not supported by relevant documents will not be considered.

4.Attach Copy of 10th Standard & 12th Standard.

5.A self addressed envelop (25 x 12 cm size) with India Postal Stamp sufficient for sending the selection memo by registered post shall also be attached.

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