Admission -2013-NRI/Management Quota

ACADEMY OF PHARMACEUTICAL SCIENCES, PARIYARAM
APPLICATION FOR ADMISSION TO M PHARM IN
PHARMACEUTICS/PHARMACOLOGY, PHARMACOGNOSY
AND PHYTOCHEMISTRY UNDER MANAGEMENT/NRI
QUOTA (2013-2014)
Application form No.:
Subject Choice: 1.
2.
Affix recent
passport size
photograph of the
applicant
3.
Note: - To be filled by the candidate in BLOCK LETTERS
(i)
(ii)
All statements made in this form must be supported with
attested copies of certificates.
The application form duly filled in should accompany of
Demand draft for the requisite amount in favour of the
Principal, Academy of Pharmaceutical Sciences, Pariyaram.
Also the candidates should specify his/her name and address
on the reverse side of the demand draft if the application
form is downloaded from the Web site.
1. Name of Candidate :
2. Father’s Name :
3. Mother’s Name :
4. Marital Status :
5. Name of Spouse :
6 Nationality :
7 State to which belong :
8 Address for correspondence :
Tel. No. with STD code :

9 Permanent Home Address :
Tel. No. with STD code :
10 e-mail i/d :
11 ACADEMIC QUALIFICATIONS: Details of Matriculation and above
Examinations only be given:
Exam
Passed
Univ./
Board
Subjects
taken
Year of
Passing
Reg
No.
Total
Marks
Marks
Obtained
Division
/Class
% of
marks
12. Professional Qualifications:
Examination
Passed
Institution
University
Year &
Month
when
passed
% of
marks
Duration
of the
course
Pharmacy
Council
Reg. No.

DECLARATION OF CANDIDATE
I hereby declare that the application has been filled in my own handwriting
and all statements made in it are true, complete and correct to the best of my
knowledge and belief and nothing has been concealed. In the event of any
statement being found false or incorrect to consider for eligibility before or after the
selection, action such as removal of my name from the rolls and/or any other action
as may be considered can be taken against me.
That I am aware of the law regarding ragging as well as the punishments
connected.
Place:
Date:
(Signature of candidate)
I undertake to state that we are aware of the law regarding ragging as well
as the punishments and agree to abide by these rules.
Place:
Date:
(Signature of Parent/Guardian)