NAJIMUDDIN INSTITUTE OF PHARMACY

Approved by PCI & Affiliated by WBSCTVESD

PCI CODE — 7841

Vill + P.O.– Godagari, P.S– Sagarpara, Dist. – Murshidabad, Pin–742305 (W.B)
najimuddinip@gmail.com | 9732883754 · 8001052870 · 8637892442

Application form for admission to D. Pharmacy

* Fields marked with an asterisk (*) are mandatory.

* Reg. No. (H.S.)

* Name of Candidate

Father's Name

Mother's Name

Guardian's Name

Date of Birth

Age

Gender

Category

IF PH(%)

Minority

Blood Group

Present Address

State

District

Pincode

Permanent Address

State

District

Mobile No. (Student)

Mobile No. (Father's)

Aadhaar No.

Pan No.

Student WhatsApp No.

E-mail

Information Academic Qualification

Name of Examination	Board / University	Year of Passing	Full Marks	Marks Obtained	% of Marks

Course

* Academic Year

Candidate Photo Upload

Candidate Signature Upload

* I declare that I shall abide by the rules and regulations of the Institution. In case any statement made above is found to be untrue, my admission shall be cancelled at any stage.