7902997111 mgmpcknr@gmail.com
MGM College of Engineering and Technology

Application Form For DPHARM

Application for Admission to DPHARM Degree Course 2020-21

( Fill in the blanks in BLOCK letters or put tick () wherever applicable

Admission Quota
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1. Name of the Candidate (In block letters)
2. Date of Birth
3. Age as on 01-01-2020
4. Gender
5. Nationality
6. Religion
7. Caste
8. Category
9. Blood Group
10.Aadhar number
11. Email
12. Permanent Address
Pin
Phone Number


13.Address For Communication
Pin
Phone Number
14(a). Father's Name
14(b). Occupation
14(c). Mobile No
15(a).Mother's Name
15(b) Occupation
15(c) Mobile No
16. Annual Income
17(a).Guardian's Name
17(b) Relation
17(c) Mobile No
18. Name of the Institution last studied
19. Board of study
20. Details of Marks secured in the plus two examination
20 a). Register No
20 b). Month & Year of passing
SubjectMark ObtainedMaximum MarksGrade
Grand Total
Total Percentage

Declaration

  • The above information is true to the best of my knowledge and belief and I understand that the admission shall be subject to satisfying eligibility conditions as per PCI/AICTE/DME and Govt. of Kerala.
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MGM Silver Jubilee Pharmacy College
Kannur MGM Technological Campus,
Vilayancode P.O. Pilathara,
Kannur – 670501, Kerala

Phone no

7902997111

Email

mgmpcknr@gmail.com

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