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(Please go through the prospectus carefully before filling the

By Danny Henderson,2014-05-27 12:27
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(Please go through the prospectus carefully before filling the

    Application Form

    Admission for First year in Kalol Institute of Pharmacy (2008-09)

    B/H. Old Janpath Hotel, National Highway, Kalol-382721 (N.G.)

     (for Office Use only) Self attested

    Passport Size Application No. Merit No.

    Photo

    (Please paste, Form received by Checked by

    do not staple)

     th1. Full Name: (as per 12 standard Mark Sheet in Block Letter)

     2. Mother‟s Name:

     3. Gender Code: (1) for male (2) for female

     D D M M Y Y Y Y

    4. Date of Birth : (as per School Leaving Certificate)

     5. Caste: (1) Open (2) SC (3) ST (4) SEBC:

     6. Details of Qualifying Examination: 6(b) Board Code:

     6. (a) Marks obtained in (1) H.S.C. (2) Gujcet. Fill (1) For Gujarat Board

     (2) For CBSE/ISCE Sr. Subject Theory Marks

     (3) For Others No. H.S.C. GujCet

     6(c) Exam Seat No. Marks Obtained Out of Marks Obtained Out of

    1. Mathamatics 2. Chemistry

    3. Physics

    4. Biology

    5. Total of Sr. No. 6(d) Month & Year of

    1, 2, 3 & 4 passing

    6. English M M Y Y Y Y

    7. Grand total

7. Merit Marks. From total Sr.No 5. of 6 (a)

     60% of H.S.C 40% of Gujcet Total Merit Marks Merit No In JAC

     th8. Details of 10 Std. Examination:

     8. (a) Total Marks Obtained 8.(b) Month & Year of Passing 8.(c) Technical :

    th Fill (Y) if 10 std. Exam passed M M Y Y Y Y

     Out of: with minimum two technical Subjects (N) Otherwise

    --------------------------------------------------------------------------------------------------------------------------------------------------------------------

     Acknowledgement

    (This acknowledgment should be produced at the time of counseling process so preserve it carefully)

Application No.__________

    Admission is First Year in Kalol Institute of Pharmacy (2008-09) Full Name:

Registration No. (For Office Use only)

8. Address for Correspondence:

    Pin Phone number with

    Code STD code.

    DECLARATION

    We herby solemnly declare that the information given above is true. If found false, we understand that my admission will be cancelled, we shall abide by the rules & norms of discipline of the Institute, candidate joins.

We have read the rules & regulations of admission carefully and agree to abide them.

We _______________________________________ („the candidate‟)

     (name of candidate)

and _______________________________________ (“the guardian”)

     (name of father/guardian)

    hereby undertake solemnly to the Principal of the Institute, where we will opt for the admission, that:

    If the candidate is granted admission in any of the self finance Pharmacy Institute of Gujarat State in academic year 2008-09 in the first year of degree Pharmacy programme.

    We agree that until we pay the fee as decided by the Management of the Institute and fee difffierence in full, we will not claim LC/TC, transcript, degree certificate, or any other papers from the Institute. Until all outstanding tuition and other fee

    amount is cleared by us, the Institute will have the fight ot deny the candidates registration, and to retain the LC/TC, transcript, degree certificate or any other papers.

    We also agree that if the candidate leaves the Institute for some reason before completing his degree programme, the candidate will pay the full fees for all the four years that he would have paid if had completed his degree programme. We thalso understand that without paying four years fee, we will not be able to claim 12 standard Mark sheet, and other relevant

    papers from the institute.

    We will abide by the rules & regulations formed by the Institute from time to time where we will opt for the admission.

     Signature of the Guardian Date Place Signature of the Candidate

List of Documents to be attached, (Xerox Copies Only)

     1. Acknowledgement Receipt of Joint Admission Committee

     th2. H.S.C. (12 Standard) Mark Sheet

     3. Gujcet. Mark Sheet

     th4. S.S.C. (10 Standard) Mark Sheet

5 SLC (School Leaving Certificate) TC (Transfer Certificate)

    6 Caste Certificate (SC or ST or SEBC with noncreamylayer certificate)

    * Receipt of the application does not assure any kind of eligibility of candidate for admission/counseling process.

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