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KERALA STATE SELF FINANCING PHARMACY COLLEGE MANAGEMENT ASSOCIATION

APPLICATION FOR ADMISSION TO B. PHARM / D. PHARM 2019-20

All fields marked with asterisk (*) must be completed

Course applied for
(Each application shall be used for only one course)*
B. PHARM   D. PHARM
College Applied*

Name in Block Letters *
Sex
Male Female
Date of Birth *
Age *
Name of Father *
Name of Mother *
Religion *
Community *
Permanent Address*
Address for Communication
Same as permanent Address
Phone No
Mobile No*
Mail Id*
Qualifying Examination *
University / Board *
Register Number, Passing Month, Passing Year *
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Marks Secured in HSE/ VHSE/ Examination

Subjects Maximum Marks Marks Secured Percentage No. of Chances
Physics
Chemistry
Biology
Mathematics
Computer Science
Biotechnology
Total Marks

Annual Income of the Family:
If the candidate is claming any reservation or other benefits, furnish details *

Application Fee Details

DD No Date Bank Amount

Declaration*

I do hereby declare that the particulars given in the application are true to the best of my knowledge and belief. If any of the particulars given by me in this application is proved fraudulent at any later stage of admission, I shall be liable for disciplinary action and my admission shall become null and void. I shall produce the originals of the certificates at the time of interview. I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.
Place:
Date:
Name & Signature of the Candidate:
Name & Signature of Parent or Guardian

Declaration *

I do hereby declare that the particulars given in the prospectus are carefully read and understood. I carefully read the prospectus thoroughly and I am ready to abide the terms and conditions mentioned in the Prospectus.
Place:
Date:
Name & Signature of the Candidate:
Name & Signature of Parent or Guardian

Notes:

  • Duly filled application form along with relevant documents and DD for Rs. 400/- in favour of Principal, Westfort College of Pharmacy' Payable at Thrissur, should be submitted to the college office
  • Application forms not supported by relevant documents will not beconsidered.
  • Attach Copy of 10th Standard & 12th Standard.
  • A self addressed envelop (25 x 12 cm size) with India Postal Stamp sufficient for sending the selection memo by registered post shall also be attached.