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DIVINE COLLEGE OF PHARMACY

Approved by Pharmacy Council of India, New Delhi

Affiliated to Department of Health Medical and Family Welfare, Patna

Patharadei, P.O. & P.S.-Ziradei, Dist, - Siwan, Bhihar, 841245 Email : divinepharmacy2019 @gmail.com | Contact No. : 82356080007 / 08


ADMISSION FORM

SESSION :
F.No. :
Course ( Please Select ) :
D. Pharm
B. Pharm
Full Name of Candidate ( As per Certificate )
Candidate's Mobile No.
Candidate's Whatsapp No.
Father's Name
Father's Ocupation
Mobile No.
Mother's Name
Date of Birth (DD/MM/YYYY)
Caste
Caste Certificate No.
Gender
Educatinal Qualification ( Start From the highest Qualification First, PCM/PCB with English Mandatory in 12th )
Title of Degree / Qualification








Name of Board University








Year of Passing








Name of School / College/Institutions








Overall Marks (% of Grade)








Majaor Subject








Permanent Address :-
Village
Post Office
Police Station
Distric
State
Pin Code
Correspondence Address :-
Village
Post Office
Police Station
Distric
State
Pin Code
Nationality
E-mail ID
Migration No.
Hostal
Tranport
None
Aadhar No.
10th Roll No.
12th Roll No.
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Approved by PCI, New Delhi & Health
Depart., Govt. Of Bihar, Affiliated by AKU,
Patna.

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