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Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

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Satya Gangeyula

The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains information such as the applicant's name, date of birth, gender, category, address, parent/guardian details, choice of exam cities, qualifying exam year, contact details, and an undertaking signed by the applicant stating that the information provided is true. It also contains the application number, date, and fee amount.

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Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

Uploaded by

Satya Gangeyula
30 views2 pages
The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains information such as the applicant's name, date of birth, gender, category, address, parent/guardian details, choice of exam cities, qualifying exam year, contact details, and an undertaking signed by the applicant stating that the information provided is true. It also contains the application number, date, and fee amount.

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The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains information such as the applicant's name, date of birth, gender, category, address, parent/guardian details, choice of exam cities, qualifying exam year, contact details, and an undertaking signed by the applicant stating that the information provided is true. It also contains the application number, date, and fee amount.

Copyright:

Attribution Non-Commercial (BY-NC)
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
30 views2 pages

Application Form: Graduate Pharmacy Aptitude Test (Gpat) - 2012 (All India Council For Technical Education)

Uploaded by

Satya Gangeyula
The document is an application form for the Graduate Pharmacy Aptitude Test (GPAT) in 2012. It contains information such as the applicant's name, date of birth, gender, category, address, parent/guardian details, choice of exam cities, qualifying exam year, contact details, and an undertaking signed by the applicant stating that the information provided is true. It also contains the application number, date, and fee amount.

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APPLICATION FORM

GRADUATE PHARMACY APTITUDE TEST(GPAT)-2012 (All India Council for Technical Education)
Application No. : 937215 Application Date : 20-02-2012 Application Fee : 1000.0

937215

1.Name of the Candidate : VUYYURI BHAARGAVI


(as given in the 10th Class Certificate)

2. Date of Birth : 30-08-1990 3. Name of Parent / Guardian : V.JAGANNAYAKULU 4. Relationship of the Parent / Guardian to the Candidate: FATHER 5. Nationality : INDIAN 6. Gender : FEMALE 7. Category : OBC 8. Person with disablility(PD) : NO 9. State / Union Territory in which your college / institute is located: ANDHRA PRADESH 10. Choice of Examination City 1 : VISHAKHAPATTANAM 11. Choice of Examination City 2 : RAJAMUNDRY 12. Year of Qualifying exam : 2011 13. Landline No. with STD code : 08912746223 14. Mobile No. : 08142027795 15. Email Address : [email protected] 16. Address for Correspondence : D-NO;38-19-68/2,JUDGE STREET

JYOTHINAGAR MARRIPALEM(P.O) VISHAKHAPATTANAM - 530018 ANDHRA PRADESH ( INDIA )


17. Bank Details : Application Fee SOL Id Transaction Number Payment Date : : : :

1000.0 513 00318397 18-02-2012

18. Place : 19. Date :

Undertaking :
I solemnly affirm that the information furnished in this application is true and correct in all respects. In the event of suppression or distortion of any fact made in this application I shall be liable to civil/ criminal prosecution and forego my claim to appear in GPAT-2012 examination, and if already appered / selected / admitted my admission / degree acquired is liable for cancellation. I agree to abide by the rules and regulations governing GPAT-2012 Examination, and as given in the website www.gpat.in

Signature of the candidate

BY SPEED/ REGISTERED POST

GPAT-2012 APPLICATION FORM


937215

Do not tamper with the bar code

TO, THE CO-ORDINATOR, GPAT 2012 SHRI G.H. PATEL PHARMACY BUILDING, OPP. UNIVERSITY MAIN OFFICE, DONORS' PLAZA, FATEHGUNJ VADODARA - 390 002 GUJARAT, INDIA

From : VUYYURI BHAARGAVI D-NO;38-19-68/2,JUDGE STREET JYOTHINAGAR MARRIPALEM(P.O) VISHAKHAPATTANAM - 530018 ANDHRA PRADESH ( INDIA )

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