B.Pharm Online Application Form
Name of Applicant :
Age :
Date of Birth :
Gender :
Male
Female
Religion :
Category / Quota :
Mobile Number :
Email :
Address :
Qualifying Exam :
Syllabus :
CBSE
STATE
ICSE
Mark Details
Physics
Chemistry
Biology
Maths
Computer Science
Total
(A)
(B)
(C)
(D)
(E)
F = (A+B)+ C or D or E
Maximum marks
Marks obtained
Total Marks obtained in Qualifying Exam :
Total Maximum Marks in Qualifying Exam :
Uploads
Upload Passport size photo :
(Only JPEG format allowed and image size should be between 20 KB to 40 KB)
Upload Scanned Signature :
(Only JPEG Format allowed and image size should be between 10 KB to 20 KB)
Application Details
Application Fee:
Rs.1000/-
Beneficiary Details
Name
Bank
Branch
IFSC
A/C NO.
Triveni Institute of Pharmacy
State Bank of India
Kecheri
SBIN0017359
40059822469
Transaction Details
Name of Bank
Branch
Transaction id
Transaction Date
Amount
Declaration
Certified that the details given above are true to the best of my knowledge and belief.I am aware that furnishing false information will be liable to disciplinary action against me.
