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    Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

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    Sam Patel
    The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains the applicant's personal information including name, date of birth, address, parent/guardian details, education details, payment details, and an undertaking agreeing to abide by the exam rules. The form was submitted on January 31, 2012 with an application fee of 1000 rupees.

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    Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

    Uploaded by

    Sam Patel
    25 views2 pages
    The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains the applicant's personal information including name, date of birth, address, parent/guardian details, education details, payment details, and an undertaking agreeing to abide by the exam rules. The form was submitted on January 31, 2012 with an application fee of 1000 rupees.

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    The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains the applicant's personal information including name, date of birth, address, parent/guardian details, education details, payment details, and an undertaking agreeing to abide by the exam rules. The form was submitted on January 31, 2012 with an application fee of 1000 rupees.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    25 views2 pages

    Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

    Uploaded by

    Sam Patel
    The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains the applicant's personal information including name, date of birth, address, parent/guardian details, education details, payment details, and an undertaking agreeing to abide by the exam rules. The form was submitted on January 31, 2012 with an application fee of 1000 rupees.

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    APPLICATION FORM

    GRADUATE PHARMACY APTITUDE TEST(GPAT)-2012 (All India Council for Technical Education)
    Application No. : 109491 Application Date : 31-01-2012 Application Fee : 1000.0

    109491

    1.Name of the Candidate : PATEL SAUMILKUMAR RAMESHBHAI


    (as given in the 10th Class Certificate)

    2. Date of Birth : 21-01-1988 3. Name of Parent / Guardian : RAMESHBHAI BABULAL PATEL 4. Relationship of the Parent / Guardian to the Candidate: FATHER 5. Nationality : INDIAN 6. Gender : MALE 7. Category : GENERAL 8. Person with disablility(PD) : NO 9. State / Union Territory in which your college / institute is located: KARNATAKA 10. Choice of Examination City 1 : VADODARA 11. Choice of Examination City 2 : AHMEDABAD 12. Year of Qualifying exam : 2011 13. Landline No. with STD code : 02767246200 14. Mobile No. : 09725451771 15. Email Address : saumilpatel1988@yahoo.com 16. Address for Correspondence : 406/A, FERTILIZERNAGAR,

    GSFC TOWNSHIP PO.FERTILIZERNAGAR VADODARA - 391750 GUJARAT ( INDIA )


    17. Bank Details : Application Fee SOL Id Transaction Number Payment Date : : : :

    1000.0 1654 00429355 24-01-2012

    18. Place : 19. Date :

    Undertaking :
    I solemnly affirm that the information furnished in this application is true and correct in all respects. In the event of suppression or distortion of any fact made in this application I shall be liable to civil/ criminal prosecution and forego my claim to appear in GPAT-2012 examination, and if already appered / selected / admitted my admission / degree acquired is liable for cancellation. I agree to abide by the rules and regulations governing GPAT-2012 Examination, and as given in the website www.gpat.in

    Signature of the candidate

    BY SPEED/ REGISTERED POST

    GPAT-2012 APPLICATION FORM


    109491

    Do not tamper with the bar code

    TO, THE CO-ORDINATOR, GPAT 2012 SHRI G.H. PATEL PHARMACY BUILDING, OPP. UNIVERSITY MAIN OFFICE, DONORS' PLAZA, FATEHGUNJ VADODARA - 390 002 GUJARAT, INDIA

    From : PATEL SAUMILKUMAR RAMESHBHAI 406/A, FERTILIZERNAGAR, GSFC TOWNSHIP PO.FERTILIZERNAGAR VADODARA - 391750 GUJARAT ( INDIA )

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