APPLICATION FORM FOR

PGP – AIET 2024-25

Name of the candidate, as it appears in B.P.Th. degree/passing certificate:

Contact no:

Date of Birth:

Candidates Photograph:

Candidates signature:

Gender:

Nationality:

Internship Training Date of Commencement:

Internship Training Date of Completion:

I.A.P. Registration:

Registration No:

Domicile of Maharashtra:

Whether admitted to and pursuing a post graduate course:

Year Wise B.P.Th Marks:

Examination	Month of passing	Year of Passing	Attempt	Total Marks Obtained	Aggregate Marks out of	Percentage
First B.P.Th. marks
Second B.P.Th. marks
Third B.P.Th. marks
Fourth B.P.Th. marks

Subject Preferences for P. G. courses:

Subject Preferences-1:

Subject Preferences-2:

Subject Preferences-3:

Test Centre-Karad:

FullName and Complete Postal Address:

Pin Code:

Declaration:

I, hereby declare that the information given in this form is true and complete to the best of my knowledge. I am aware that if any information given herein is found to be incorrect or incomplete, my application will be rejected/ admission will be cancelled.