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    Iitbhu Appform

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    bhaibehen3022

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    © All Rights Reserved
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    Iitbhu Appform

    Uploaded by

    bhaibehen3022
    13 views2 pages

    Original Title

    IITBHU_APPFORM

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    © © All Rights Reserved

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    Copyright:

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    13 views2 pages

    Iitbhu Appform

    Uploaded by

    bhaibehen3022

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Application Form for M.Tech./M.Pharm.

    Programme

    Application No.: 22100042


    Date & Time of Submission: 2022-05-23 17:46:32.689147

    1. Personal Information

    FULL NAME : SHIVANGI SINGH


    MOTHER's NAME : REKHA SINGH
    FATHER's NAME : RAVINDRA KUMAR SINGH
    Date of Birth : 22-05-2001
    Email : singhshivaangii@gmail.com Gender : Female
    Nationality : Indian Category : GEN
    Physically Challenged ? : No
    Mobile Number : 9125317921
    Correspondence Address: C 4232 SECTOR 6 RAJAJIPURAM LUCKNOW (PINCODE 226017)
    Permanent Address : C 4232 SECTOR 6 RAJAJIPURAM LUCKNOW (PINCODE 226017)
    State : Uttar Pradesh
    COAP Registration No.:

    2. Application Fee Details


    Application Fee : 500
    E-receipt no. : DUJ0391005
    Date of Payment : 2022-05-23

    3. Programme Selection :
    Registration Category : Full-Time Regular

    3A. Select the Primary Programme you are applying for (Compulsory) :
    Programme : M.Pharm
    Department/School: Pharmaceutical Engineering and Technology
    Discipline: Pharmacy
    Spec 1:PHARMACEUTICS
    Spec 2:PHARMACOGNOSY
    Spec 3:PHARMACOLOGY
    Spec 4:PHARMACEUTICAL CHEMISTRY
    Spec 5:NA
    Spec 6:NA
    Spec 7:NA
    3B. Additional Programme 1 : 3C. Additional Programme 2 :
    Programme : null Programme : null
    Dept/School:null Dept/School: null
    Discipline: null Discipline: null
    Spec 1:null Spec 1:null
    Spec 2:null Spec 2:null
    Spec 3:null Spec 3:null
    Spec 4:null Spec 4:null
    Spec 5:null Spec 5:null
    Spec 6:null Spec 6:null
    Spec 7:null Spec 7:null

    Spec = Specialization
    4. Details of GATE/GPAT (Mandatory for Full-Time Regular Category) :

    GATE/GPAT Qualified : Yes Is Your GATE/GPAT Score Valid : Yes


    Name of the Exam : GPAT
    Reg./Rollno. 220210000075
    Exam discipline : PHARMACY
    Exam Year : 2022
    Exam Rank : 1155
    Exam Score : 161
    5. Academic Details :
    5A. Qualifying Degree details : 5B. Other Degree details :
    Degree : UG Degree Degree :
    Degree Status : Appearing Degree Status :
    Degree Name : BPharm Degree Name :
    University : BANASTHALI VIDYAPITHUniversity :
    Discipline : PHARMACY Discipline :
    Exam Year : 2022 Exam Year :
    % or CGPA : 82.5 % or CGPA :
    5C. Intermediate (10+2):
    Name of Certificate : INTERMEDIATE
    Name of Board : CISCE
    Subjects : PCB
    Year of Passing : 2018
    Final Aggregate % or CGPA: 85.5
    5D. High School (10th):
    Name of Certificate : HIGH SCHOOL
    Name of Board : CISCE
    Subjects : SCIENCE
    Year of Passing : 2016
    Final Aggregate % or CGPA: 94

    6. Work Experience(Mandatory if applying under sponsored category):


    First Work Experience : Second Work Experience :
    Period from : Period from :
    Period to : Period to :
    Organization : Organization :
    Position : Position :

    7. Declaration:
    I declare that the information provided by me on this application form is correct to the
    best of my knowledge and belief. I understand that any wilful misinterpretation of facts
    will result in my disqualification and dismissal from the Institute if admitted.

    Candidate signature

    Application no.: 22100042


    Date & Time of Submission: 2022-05-23 17:46:32.689147

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