आवेदन पत्र
Sagar Institute of Technology & Management
(Department of Pharmacy)
Barabanki
Please enter all the fields correctly.
University Enrollment No.
:
Course
:
Admission Mode
--
UPSEE/JEE
Management
Others
Handicap
Category
--
General
SC
ST
OBC
Caste
--
Hindu
Muslim
Christian
Shikh
Buddhist
English Name
:
Hindi Name
:
Date of Birth
:
Gender
--
Male
Female
Blood Group
--
A
B
AB
O
RH Factor
--
Positive
Negative
Aadhar No.
:
Email ID
Mobile
Father Name
:
Occupation
Mobile
Mother Name
:
Occupation
Mobile
Photo
:
(png, jpg/jpeg or gif)
Signature
:
(png, jpg/jpeg or gif)
Educational Qualification
Exam
Board/Univ.
Pass Year
Div.
Percentage Marks
Agg. %
Phy
Chem
Bio
Math
Eng
High School
I
II
III
Intermediate
I
II
III
Diploma
I
II
III
Scholarship
:
(Distinction/Honours/Award)
Permanent Address
Address
:
State
:
City
PIN
Phone
:
Email
Local Address
same as permanent.
Local Guardian
:
Address
:
State
:
City
PIN
Phone
:
Email
Annual Income
:
Bus Facility
Submission Date
Sports
:
Other Activities
:
Documents attached
X Mark Sheet
Transfer/Migration Certificate
Medical Certificate
X Certificate
Income Certificate
Caste Certificate
XII Mark Sheet
Graduation Mark Sheet
Domicile Certificate
XII Certificate
GAP Affidavit Certificate
Character Certificate
