IIMT UNIVERSITY, MEERUT

Established by Govt. of U.P. Act No.32 of 2016

IIMT University Enrollment Form 2019

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Name of College IIMT College of Medical Sciences * Enrollment No. 20190121

BACHELOR OF PHARMACY
Name of Course Nationality Indian *
*

College Code 65 * Upload Recent Photo* Upload Signature*

Choose File No file chosen Choose File No file chosen
Name of Candidate Mr. Mohd Hasim *
Upload Upload
Father's Name Vakeel *

Mother's Name Sabra *

Date of Birth Mar 2 2001 *

Gender Male Female Transgender

Category GEN. S.C. S.T. O.B.C

Physical Handicap NO YES

Aadhar Number 871020266982 *

Village Pachpera post siyal dist Meerut Tehsil City Meerut *

Meerut Block Rajpura
State Up *
Address for Correspondence
Mob. No 7078692820 *

E-Mail ID ohdhasim2500786@gmail.com *
*

Fill High School Details

Subject-1 Subject-2 Subject-3 Subject-4 Subject-5 Subje

Name of Subject Hindi English Mathematics Science Social Scienc Drawin
Marks Obtained/Grade 100 100 100 100 100 100
Max Marks(Write N.A. if garde) 69 58 51 61 60 69

Fill Intermediate School Details

Subject-1 Subject-2 Subject-3 Subject-4 Subject-5 Subje

Name of Subject General Hind English Physics Chemistry Biology

Marks Obtained/Grade 100 100 100 100 100

Max Marks(Write N.A. if garde) 69 65 50 49 51

Percentage of marks obtained in qualifying level examination

For Engg. Diploma holders for admission in 2nd year
Name of Branch in Diploma Roll No. in Diploma Course % of Marks obtained in Diploma Exam

In case of MBA/B.Ed./M.Ed./B.P.E.S/M.Pharma/M.Sc./M.Tech/MPT/B.P.Ed., Write details of qualifying Examination inculding name of the University.

S.No. Name of University Qualifing Exam Year of Passing Subjects % of Marks

In case of MCA, also write details of quakifying Maths Subject in Intermediate/Graduation level.

S.No. Name of University Qualifing Exam Year of Passing Subjects % of Marks

1
 Transfer/Migration Certificate from Institution/Board/University last attended is required to be annexed in original with this Enrollment from. If certificate is attached write ‘’Yes’’ Otherwise
the relevant box along with details of certificate

YES NO

If NO then Details of Transfer/Migration Certificate

DECLARATION BY CANDIDATE
1.I have read the rules, relevant Ordinances and undertake to abide by them and will not claim any Benefit out of any error or mistake on the part of the University office and further declare that I
appearing at any other examination of this University or any other University not allowed under the ordinances.
2. I, hereby declare that I understand, unless I fulfill the minimal attendance criteria i.e 75%, I will not be eligible to appear for the examinations.
3. I, hereby declare that the entries in the form are true to the best of my knowledge and belief. In case any entry in this form is found to be false, I will have no objection if the University disqualifi
from appearing in the examination / cancel my Examination and debars me from appearing in the Examination in future.
4. I, further declare that I will have no objection for being searched by an official deputed by the Superintendent of the examination or by the Vice-Chancellor/Pro-Vice Chancellor/Registrar/Contr
Examination during the course of Examination.
5. I, declare that in the event of boycott or walkout in any paper, I shall agree to be marked absent in that paper and/or the award of punishment as the University may give or impose.
6. I, declare that I have not been punished for using unfair means at any Examination.
7. I, declare that I fulfill the minimum eligibility criteria for admission in UG, PG, and Diploma& Certificate Courses.

S.No Particulars Yes No NA

1 High School Marksheet and Certificate YES NO NA

2 Intermediate Marksheet and Certificate YES NO NA

3 Polytechnic Marksheet and Certificate YES NO NA

4 Graduation Marksheet and Certificate YES NO NA

5 Post Graduation Marksheet and Certificate YES NO NA

6 Transfer Certifiacte (TC) (Original) YES NO NA

7 Migration Certifiacte (TC) (Original) YES NO NA

8 Aadhar Card YES NO NA

9 2 Passport size coloured photos YES NO NA

Place:    MEERUT                  Date:           10/1/2019                  

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