NIMSRLC | Admission Form 2025-26

Program

Applicant

Parents

Address

Education

Photo/Sign

PROGRAM TYPE

D.PHARM B.PHARM B.PHARM (L)

Session Year *

APPLICANT DETAILS

PARENTS / GUARDIAN DETAILS

* Guardian details only if different from parents

Father's Details

Mother's Details

Guardian Details (if different from parents)

PERMANENT ADDRESS

EDUCATIONAL QUALIFICATIONS

10th / Madhyamik

10+2 / Higher Secondary

Diploma (Lateral Entry)

Declaration Date *

Place *

PHOTOGRAPH & SIGNATURE

Upload Passport Photo

Upload Signature

I hereby declare that all the details mentioned above are true and correct to the best of my knowledge. I understand that any false information may lead to cancellation of my admission.

Admission Form 2025-26