Kunwar Haribansh singh college of Pharmacy

Enrolment Form

Thanks for registering with Kunwar Haribansh singh college of Pharmacy! It's free and a simple process.

REGISTRATION APPLICATION FORM FOR COURSE
1. Registration Details*Mandatory fields
Registration sought for*	-Select- B.Pharma M.Pharma
2. Applicant's Personal Details
Applicant's full name *	( Full name as per the highest / latest qualification certificate or legal certificate )
Father's Name*	( Full Name As Per Educational/Legal Certificate )
Mother's Name*	( Full Name As Per Educational/Legal Certificate )
Gender*	Male Female
Date of Birth* (dd-Mon-yyyy)	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Month 1 2 3 4 5 6 7 8 9 10 11 12 / Year 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 ( As per high school certificate in 'dd-Mon-yyyy' format. i.e. '01-Jan-1990' )
Category*	--Select One-- General Scheduled Caste Scheduled Tribe Other Backward Class
3. Contact Details
Mobile Number*
Email Address	(e.g.abc@yahoo.com)
Father's Contact No.*
4. Address Details
Address Line*
City Name*
State*	--State-- Andaman and Nicobar Islands Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh Chhattisgarh Dadra and Nagar Haveli Daman and Diu National Capital Territory of Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Puducherry Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal
District*	--Select One--
Pin Code*
4. Educational / Qualification Details
SL.No. Qualification Board/University Passing Year Marks Percentage 1. High School*  2. Intermediate* 3. Graduation
6. Qualifying subjects
Physics Marks Chemistry Marks Biology/Math Marks
Upload Photo*	( JPG,JPEG,GIF,PNG image with size upto 50 KB )
7. Declaration
I, hereby declare that the particulars submitted by me in the online application form of KHBS are true to the best of my knowledge and belief. I agree to abide by the rules and regulations of KHBS and also to the decision of KHBS regarding any action. I will not held KHBS responsible for any damages.
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