Admission Form 2024

Upload Passport Size Photograph (Max file size : 1MB , Allow file type : jpg,jpeg,png,pdf only. )

COURSE

D PharmaB Pharma
I am submitting my application as under:

A) GENERAL INFORMATION

(IN BLOCK LETTERS) (Name of the applicant should be As per HSC Marks Statement / In case of name change, attach the required document.)

Name:

Contact Email:

Contact No:

Alternate Contact No.:

Adhar Card No.:

PAN No.:

Passport No. :

Valid Till

(Ensure your contact no. is correctly recorded as Suryadatta sends many important messages via SMS. Any change in Address / Contact No. / Email must be communicated to Suryadatta immediately.)

Date Of Birth

Age (as on 1st July 2022)

Gender:

Nationality

Religion

Father / Guardian’s Name

Professional Background of Father/Guardian

Designation (Father/Guardian)

Mobile No (Father/Guardian)

Residence No.(including STD Code)

Mother Name

Professional Background of Mother

Designation (Mother/Guardian)

Email Id (Father/Mother/Guardian)

Alternate Email Id (Father/Mother/Guardian)

Family’s Yearly Income

Sources of Income

Do you have any Brother(s), Sister (s). If so, their name & present occupation

B) POSTAL ADDRESS

Communication Address

Country

State

City

Pincode

Permanent Address

Country

State

City

Pincode

C) DETAILS TO BE FILLED BY FOREIGN STUDENTS

Passport No.

Passport Issued

Valid Till

Visa No.

Visa Type

Valid Till

Nationality

Country

Any Relative in Pune / India : Name

Relationship

Contact No.

Email Id

Address

University Exam Given

D) ACADEMIC DETAILS (DEGREE / DIPLOMA)

It is mandatory to mention your academic details, without which, your form will not be processed.

10th Board Exam

12th Board Exam

Diploma, if any :

Graduation Specify :

Any Other :

Other Examinations (Please specify)

DETAILS OF NEET

NEET Roll No.

Marks Obtained in Neet Subject

Computer Literacy

E) Industry Work Experience If Any

Experience 1:

Experience 2:

F) EXTRA-CURRICULAR ACTIVITIES

This is not a compulsory part. Only those claims which can be substantiated with legitimate certificates need to be mentioned here. Attach separate sheet if required. List not more than three significant achievements in extra-curricular activities.

Activity 1

Activity 2

Language KnownEnglishHindiOther

Hobbies & Interest

Mention your Strengths and Areas of Improvement

Why do you think SURYADATTA is the best option for you?:

Health Records

G) Other Details

If from reserved category, attach Non Creamy Layer, Cast Validity Certificate from competent Govt. authorities.YesNo

b) Are you attaching your Domicile & Nationality CertificateYesNo

c) Are you a physically handicapped candidate : If yes, attach disability certificate from competent authorities.YesNo

d) Are you an outstanding performer in Academics (Medalist or Rank Holder) in the University / Board. If yes, attach supporting document signed by competent authoritiesYesNo

e) For Master Degree courses : Have you passed your Bachelor’s Degree from a recognized University?YesNo

f) Did you have any gap in your continued education. If yes, attach your gap certificate stating reasons for the same.YesNo

Your source of information about our Course : (Please tick wherever applicable)

a) MH-CET CELLYesNo

b) MagazineYesNo

c) InternetYesNo

d) AlumniYesNo

e) Current StudentsYesNo

f) Parental ReferenceYesNo

g) Any Other Source

Hostel Facility : Only BoardingBoarding & MessNo

Preferred mode of Payment for fees Own SourceEducation Loan

Documents to be submitted - Copies only

1. Mark sheets of all examinations

2. Transfer Certificate & Migration Certificate

Note : Original Degree / Diploma Certificates need not be attached at this stage. Original Certificates are required at the time of admission. Those students who are in the final year of Degree course should meet the eligibility criteria on the completion of the course. Those not meeting the eligibility criteria of the Institute will attract cancellation of admission.
Students can collect their original documents after clearing all dues & getting a ‘No Dues’ certificate from the Institute authorities.

H. RULES & REGULATIONS

Read Rules & Regulations Click here

I) DECLARATION

I Confirm that above information is correct and have read the rules and regulations carefully and will follow the same.

A) GENERAL INFORMATION

B) POSTAL ADDRESS

C) DETAILS TO BE FILLED BY FOREIGN STUDENTS

D) ACADEMIC DETAILS (DEGREE / DIPLOMA)

E) Industry Work Experience If Any

F) EXTRA-CURRICULAR ACTIVITIES

G) Other Details

H. RULES & REGULATIONS

I) DECLARATION

Quick Enquiry