Application Form Thanks for registering with Kunwar Ajeet college of Pharmacy! It's free and a simple process. REGISTRATION APPLICATION FORM FOR COURSE 1. Course Details*Mandatory fields Course* -Select- B.Pharma D.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 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Month 1 2 3 4 5 6 7 8 9 10 11 12 / Year 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 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 OBC SC ST 3. Contact Details Mobile Number* Alternate Mobile No. Email Address* 4. Address Details Address* 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 High School Intermediate Graduation Diploma 5. Qualifying Subjects PCM PCB Diploma 6. Declaration I, hereby declare that the particulars submitted by me in the online application form of KHBS are true to the best of my knowledge and belief. I agree to abide by the rules and regulations of KHBS and also to the decision of KHBS regarding any action. I will not held KHBS responsible for any damages. Enter Captcha Text Enter the code above here : Can't read the image? click here to refresh.
