Graduate Pharmacy Aptitude Test

GPAT - 2020
Confirmation Page

Application No. 2002 1002 5192 -

DO NOT SEND THIS PAGE TO BOARD.
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Candidate's Name CHHAYA BAI TEMBHURNE Date of Birth 29-05-1991
Mother's Name AHILYA TEMBHURNE Category SC
Father's Name VISHWANATH TEMBHURNE Gender Female
If you are a PwD Candidate, do you have No Nationality Indian
benchmark disability (40% or more /
“Severe” where percentage is not defined)
?
State/ UT of Residence CHHATTISGARH Are You Diabetic? NO

Applied For
Applied For GPAT 2020 Choice for Examination City CHHATTISGARH - RAIPUR

Contact Details
Address DEVENDRA NAGAR PARAS NAGAR NEAR MASJID Locality RAIPUR
City/Town/Village RAIPUR District RAIPUR
State /UT CHHATTISGARH Pin Code 492009
Email Address chh**************@gmail.com Mobile Number (+91) 810****379
Alternate Mobile 9399210779
Number

Fee Payment Details

Payment Mode: Pay through HDFC Bank Transaction ID: 9379620127
Exam Fee: 800 /- Date of Transaction: 20/11/2019 11:59:23
Fee Submitted On: 20/11/2019
DECLARATION
I hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the Information Bulletin for GPAT -
2020 and understood the procedures. I shall abide by the terms and conditions thereon.

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IP Address : 182.77.70.171 Date of Downloading : 20/11/2019 11:59:42 AM