This document is an examination form for a student named Kundan Kumar (Roll No: 1115561) attending PCTEIP, Jhanday for the B.Pharma program. The form lists the subjects the student is appearing for in the December 2011 semester examination, including 6 theory and 4 practical subjects. It also includes details of the student like father's name, mobile number, and batch. The student and principal have signed to certify eligibility to appear in the examination as a regular student as per university regulations. The form acknowledges receipt of examination fees paid.

1. EXAMINATION FORM FOR EXAMINATION: Dec-2011
For Regular Semester Only Entry Date :-14 Nov 2011
Institute PCTEIP, Jhanday
Branch B.Pharma Affix photograph to
be attested by
Roll No / Name 1115561/KUNDAN KUMAR principal/ Competent
Authority
Father / Mother Name RAJKUMAR VIDYARTHI/USHA DEVI
Mobile / Email / Batch 9463670257//2011
Subjects in which appearing
Subject Code / Paper Id Subject Title / Remarks T/P Internal External
Sem1
BPHM101 / D1102 Pharmacognosy-I Theory Yes Yes
BPHM102 / D1103 Pharmaceutical Chemistry-I Theory Yes Yes
BPHM103 / D1104 Pharmaceutical Analysis-I Theory Yes Yes
BPHM104 / D1105 Computer Science & Application Theory Yes Yes
BPHM105 / D1106 Introduction to Dosage Form Theory Yes Yes
BTHU101 / D1101 Communicative English Theory Yes Yes
BPHM106 Lab Pharmacognosy-I Practical Yes Yes
BPHM107 Lab Pharmaceutical Chemistry-I Practical Yes Yes
BPHM108 Lab Pharmaceutical Analysis-I Practical Yes Yes
BPHM109 Lab Computer Science & Application Practical Yes Yes
I have understood all the regulations and its amendments in regard to examinations. I found myself Eligible to appear in
Examination. In case University declare me ineligible due to any wrong information submitted in examination form by me, I shall
be responsible for the consequences at any stage.
Sign of Candidate ________________________ Sign with ball pen __________ Date___________________
Certified that the Candidate has completed the prescribed course of study and fulfilled all the conditions laid down in the
Regulations for the examination and is eligible to appear in the examination as a regular student of Punjab Technical University.
The candidate bears a good moral character and particulars filled by him/her are correct.
Signature of the Principal / Competent
Authority (With Seal and Date) ________________________ (Signature of HOD)
Receipt of Regular Examination Form and Examination Fee for Examination Dec-2011
Received Regular Examination Form of Sem1th and Examination Fee of Rs._________________ and late fee (if any) Rs.
___________ from Student Name:KUNDAN KUMAR and Student RollNo:1115561.
Signature of Institute Dealing Head with seal