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Freshers Contact Details Enrollment
Contact details enrollment form for the 1st year students AY 2017 - 18 D Pharm, B Pharm, Pharm D & M Pharm courses of Krupanidhi College of Pharmacy.
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* Indicates required question
Name
*
enter your name as it appears in your PUC marks Card
Your answer
Date of Birth
*
enter your Date of Birth in DD/MM/YYYY as it appears in your PUC marks card
MM
/
DD
/
YYYY
Gender
*
Please select your gender
Choose
Female
Male
Transgender
Course Joined
*
Please select the name of your course you have enrolled
Choose
1 D Pharm
1 B Pharm
1 Pharm D
Pharm D (PB)
M Ph (Pharmaceutics)
M Ph (Pharmacology)
M Ph (Quality Assurance)
Phone Number
*
Your answer
email id
*
Your answer
Father's Name
*
Your answer
Father's Phone number
*
Your answer
Mother's Name
*
Your answer
Mother's Phone Number
*
Your answer
Parent's email id
*
Your answer
Permanent Address
*
Your answer
Local Address
*
Your answer
Name of Local Guardian
*
Your answer
Local Guardian' Address
*
Your answer
Local Guardian' Phone Number
*
Your answer
Your Blood Group
*
Choose
O+
O-
A+
A-
B+
B-
AB+
AB-
Emergency Contact Number
*
Your answer
Nationality
*
fill your nationality
Your answer
Identity Document number
*
Please enter your Aadhar Number f your are Indian national, if you are an international student enter your Passport number.
Your answer
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