Sree Ramkrishna College of Pharmacy

SREE RAMKRISHNA COLLEGE OF PHARMACY

Vill:- Barkuri, P.O.:- Panchrahat, P.S.:- Khayrasole, Dist:- Birbhum, Pin:- 731133

Phone Number:- +91 9064639905 | E-mail Id:- srkcpharmacy@gmail.com

ADMISSION FORM

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ADMISSION FORM

ADMISSION FORM

Form No:

Admission No.:

Date:

Course Applied For:

Admission Through:

Academic Year:

STUDENT’S RANK INFORMATION

Student Name (Block Letters):

Entrance Examination Appeared for:

Roll No.:

Rank/Scores:

STUDENT’S PERSONAL DETAILS

Student Email ID:

Contact No.:

Emergency Contact No.:

Nationality:

Religion:

Date of Birth:

Blood Group:

Gender:

Category:

Aadhaar Card Number:

Marks of Identification:

Medical Condition (if any):

Father’s Name:

Occupation & Contact No.:

Mother’s Name:

Mother’s Contact No.:

Total Annual Income of the Family (INR):

Permanent Address:

VILL./P.O.:

District:

State:

Pin Code:

Mobile No.:

Email ID:

Guardian’s Name:

Relationship (if father is not alive):

Local Guardian’s Name:

Relationship:

Occupation:

Hostel Facility Required:

Results of Class 10 & Higher Secondary (10+2)

Class	Board	Year	Division/%	Subjects Taken
10

10+2 (WBJEE/JEE MAIN)

Name & Address of Institution:

Subject	Marks Scored
Physics
Chemistry
Mathematics
Biology
English
Additional Subject 1
Additional Subject 2

Year Of Passing:

Declaration by Student

I hereby declare that the information given is true and agree to abide by institute rules...

Date: Place:

Upload Signature:

Declaration by Parent/Guardian

I understand that this form does not confirm admission...

I, Father/Mother/Guardian of: Course: Name of Declarer: Relationship: Date: Place:

Signature of Declarer

OFFICE USE

Student’s Name:	Contact No.:
Guardian Name:	Contact No.:
Email ID:	Date of Admission:
Ref:	Mobile:
Add/Telephone/Social Media/Facebook: