Application Form for Admission to B.Pharm Course
(To be filled in by the applicant in block letters. Incomplete application will not be entertained)

PERSONAL DETAILS

ADDITIONAL INFORMATION

ACADEMIC DETAILS

Subject
Marks Secured
Max. Marks
% of Marks
Part I English
Part II Additional Language/ Subject
Part III Optional Subjects
a) Physics
b) Chemistry
c) Biology
d) Mathematics
e) Computer Science
Total

Common Entrance Examination Details KEAM

Roll. No.
Marks Obtained
Percentage of Marks
Over All Rank
Category Rank
PH Rank
Mark list & +2 certificate
Allotment letter
Eligilibility certificate
SSLC or equivalent certificate

Declaration

I hereby declare that the above details provided are correct and precise to the best of my knowledge.