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College code : D.PHARM (4868) and B.PHARM (1067)
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Thanks for registering with Mission Pharmacy College! It's free and a simple process.
REGISTRATION APPLICATION FORM FOR COURSE
1. Registration Details
*
Mandatory fields
Registration sought for
*
-Select-
B.Pharma
M.Pharma
2. Applicant's Personal Details
Applicant's full name
*
( Full name as per the highest / latest qualification certificate or legal certificate )
Father's Name
*
( Full Name As Per Educational/Legal Certificate )
Mother's Name
*
( Full Name As Per Educational/Legal Certificate )
Gender
*
Male
Female
Date of Birth
*
(dd-Mon-yyyy)
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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31
/
Month
1
2
3
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5
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11
12
/
Year
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
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1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )
Category
*
--Select One--
General
Scheduled Caste
Scheduled Tribe
Other Backward Class
3. Contact Details
Mobile Number
*
Email Address
(e.g.abc@yahoo.com)
Father's Contact No.
*
4. Address Details
Address Line
*
City Name
*
State
*
--State--
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
National Capital Territory of Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
District
*
--Select One--
Pin Code
*
4. Educational / Qualification Details
SL.No.
Qualification
Board/University
Passing Year
Marks
Percentage
1.
High School
*
2.
Intermediate
*
3.
Graduation
6. Qualifying subjects
Physics Marks
Chemistry Marks
Biology/Math Marks
Upload Photo
*
( JPG,JPEG,GIF,PNG image with size upto 50 KB )
7. Declaration
I, hereby declare that the particulars submitted by me in the online application form of Mission Pharmacy College are true to the best of my knowledge and belief. I agree to abide by the rules and regulations of Mission Pharmacy College and also to the decision of Mission Pharmacy College regarding any action. I will not held Mission Pharmacy College responsible for any damages.
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