Candidate Declaration Form Please enable JavaScript in your browser to complete this form.Name *FirstMiddleLastDate of Birth *Place of Birth *Nationality *GenderMaleFemaleOtherEmail *Mobile No *10 Digit Mobile NumberAlternate Mobile No *10 Digit Mobile NumberParent/Guardian Name *FirstLastParent/Guardian Phone *Parent/Guardian Email *Education *BScMScB PharmM PharmPhDDiploma ChemicalBE/B Tech ChemicalME/M Tech ChemicalMBAOTHERHave you ever been charged or convicted for criminal offence in your state , nation or abroad? *YesNoPermission & Agreement *I agree and give my permissionI certify that the above information I have written on the application form and the documents I have submitted to be true and accurate.Submit