1. Student Registration Proforma
Kerala University of Health Sciences
Thrissur-680 596
Proforma-Student Registration
(Report Generated On:2014-10-21)
1. Year of Admission : 2014
2. Course Level : PG ParaMedical
3. Course : M.Pharm - Pharmaceutical Chemistry
4. Sub Speciality (if any) : -
5. Name of College : Govt. Medical College, Thiruvananthapuram
6. Name of Candidate : GEETHU S
7. Temporary Student ID : 201403320
8. Entrance Examination Details
Name of Examination Authority Reg.No. Rank No Year Admission Quota
GPAT AICTE 37912929
5
3493 2014 1
9. Personal Details
Sex FEMALE Address for Communication
Date of Birth 1991-05-16
Blood Group B- ARYOTTUKONAM KIZHAKKIN KARA VEEDU
Name of Parent/Guardian GANESH KUMAR T
Relation with
FATHER
Parent/Guardian
Mobile No 09562791736 District Trivandrum
Email ID geethuganesh016@gmail.com State Kerala
Category SC Country India
Religion HINDU Pin Code 695523
Caste Pulaya(SC)
Nativity Keralite Nationality Indian
10. Details of Qualifying Examination
Name of Qualifying Examination Reg.No Year Percentage
of Marks
Percentage of Marks
(In Case of UG
Courses)
PCB Biology
Division/
Grade
Board/University
B PHARM 6426 2014 73.00 0.00 0.00 FIRST
CLASS
KERALA
UNIVERSITY
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2. Student Registration Proforma
11. Details of Intership, if any
Period From Period To Name & Address of Institution
2013-03-16 2013-04-30 CHENNAT PHARMACEUTICALS PVT LIMITED, ALAPPUZHA,
KERALA
12. Other Details, if any
Migration Certificate,if any NO
Equivalence Certificate,if any NO
Council Registration Certificate,if any NO
13. Any Other Relevant Details, if any
NO
DECLARATION
I..............GEETHU S............... hereby agree that the forgoing information is correct and complete to the best of
my knowledge and belief, nothing has been concealed/distorted. If I am found to have concealed/distorted, any material
information,the University shall be able to take action against me and summarily cancel my registration and
admission,and also agree to abide by the Rules and Regulations of the University.
Place : Signature
Date : Name of Student
Verified with actual records and found correct
Place :
Date : College Seal Name & Signature of Principal
FOR OFFICE USE ONLY
Registration Sanctioned/Cancelled & Reason
Name & Signature of Official
Please Note:
Category Codes & Description Nativity Codes & Description
Gen-General OCI-Overseas Citizen of India
EZ-Ezhava PIO-Person of India Origin
MU-Muslim AIS-All India Service
BH-Backward Hindu
LC-Latin Catholic(Other than Anglo Indian
BX-BackwardChristian
KU-Kudumbi
SC-Scheduled Caste
ST-Scheduled Tribe
OE-Other Eligible Cimmunity
AI-Anglo Indian
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