Form Fee Rs. 300/-Form No. :

APPLICATION FORM FOR ADMISSIONIN M.PHARM 1st YEAR (SEM-I)

COURSE UNDER MANAGEMENT QUOTA /VACANT SEATS YEAR 2016-2017

S. J. Thakkar Pharmacy College

Opp. Drive-in-Cinema, Near N.R.I. Bungalow, Avadh Road, Kalawad Road, Rajkot-360005 (M) 90990 63164, 99251 20620 Web:sjtpc.com E-mail :

(Surname)(Name) (Father’s Name)

Name of

Applicant

(In Capital Letter as per B. Pharm Mark sheet)

FOR OFFICE USE ONLY

Merit No. of ACPC

Recent
Passport
Size
Photograph

Merit No. of Institute

Interested M. Pharm

Branch

B. Pharm aggregate %

GPAT-2016 Marks

CET – 2016 Marks

Checked By:______Verified By: ______

  1. Candidate Name as per B. Pharm Mark Sheet

(Surname)(Name)(Father’s name)(Mother’s Name)

  1. University from Which B. Pharm Passed :
  2. Seat No. of Final Year B. Pharm :
  3. Month & Year of Passing B. Pharm:
  4. Seat No. of GPAT-2016 / CET-2016:
  5. Gender:
  6. Date of Birth and Birth Place:

SC / ST / SEBC / GEN.
  1. Category:(Tick in Relevant Box)
  2. Calculation of Merits marks on the basis of marks obtained in B. Pharm.

B. Pharm
Sem-V / B. Pharm Sem-VI / B. Pharm Sem-VII / B. Pharm Sem-VIII / Aggregate in B. Pharm / GPAT 2016 Score / CET
2016 Score
SPI
CPI
  1. Interested Branch of M. Pharm:-______
  1. Pharmacology
  2. Pharmaceutics
  3. Quality Assurance
  4. Pharma Analysis
  5. Pharmaceutical Management & Regulatory Affairs
  1. Write address for correspondence with all contact details.

______

Contact______(R.)______E-mail ID______

List of copy of the documents to be attached for Student (Please √ in the box.)

a)H.S.C. (12th) Mark sheet of all attempt

b)School Leaving Certificate (SLC)/Transfer Certificate (TC) and evidence of place of when it is not mentioned in SLC/TC.

c)Marksheet of all Semester of B. Pharm with all attaempts.

d)GPAT-2016 Score card / CET-2016Marks

e)Degree Certificate.

f)Domicile certificate.

Declaration

I do hereby declare that all the particulars stated in the application are true and correct to the best of my knowledge and belief. In the event of suppression or distortion of my information provided in my application form, 1 understand that admission granted by the institute shall be liable for cancellation, I also understand that the decision of the institute regarding my admission shall be final and I shall be abide by its decision. Further, if admitted, I promise to abide by the rules and regulations of the institute as applicable during the course of study, I abide to pay the fees as determined by the Fee Regulatory Committee (Technical) time to time.

Date: / / 2016

Place:

______

Signature of Parent/Guardian Signature of the Candidate

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