FILL ONLINE ADMISSION FORM FILL PERSONAL DETAILS Class* : Select Class B.Pharma D.Pharma Subjects* : Web Registration No : Refered By : Student Name* : Father's Name* : Mother's Name : Category : -Select- General OBC SC ST Minority Other Guardian's Name (if any) : Relation with Student : Guardian's Mobile No : Date Of Birth* : Gender : Male Female Permanent Address* : City : Correspondence Address : Correspondence City : Pincode* : E-mail Id : Annual Income : Religion : Select Religion Hindu Muslim Sikkha Christian Other Mobile No.(for SMS)* : Aadhar No: Labour Card No: Bank Account No : Bank IFSC Code : Bank Name & Branch : Parent Contact No : FILL 10TH & 12TH DETAILS 10th College Name : 10th Roll No : 10th College Board : UP BOARD AGRA UNIVERSITY CBSE ICSC RJ BOARD OTHER UNIVERSITY 10th Passing Year : 10th Maximum Marks : 10th Obtained Marks : 12th College Name : 12th Roll No : 12t Board : UP BOARD AGRA UNIVERSITY CBSE ICSC RJ BOARD OTHER UNIVERSITY 12th Passing Year : 12th Maximum Marks : 12th Obtained Marks : FILL GRADUATION DETAILS Graduation College Name: Graduation Roll No : Graduation College Board: SELECT BOARD AGRA UNIVERSITY OTHERS Graduation Passing Year : Graduation Max. Marks: Graduation Obtained Marks : FILL DOCUMENT DETAILS Income Certificate No : Income Certificate Date : Income Certi. Application No : Cast Certificate No : Cast Certificate Date : Cast Certi. Application No : Domicile Certificate No : Domicile Certificate Date : Domicile Certi. Application No :