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  • The Aga Khan University Fellowship Programme Application Form

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    This document is an application form for the Aga Khan University Fellowship Programme submitted by Dr. Mansoor Ahmed Mazari. It provides his personal details such as name, date of birth, nationality, contact information, medical education history, residency details, qualifications, and a checklist of required documents to submit with the application. The form seeks information about his medical college, house jobs, residency program, qualifications like FCPS parts 1 and 2, PMDC registration, and other experience. It is endorsed by his supervisor/principal and includes a list of documents that must be attached like mark sheets, degrees, registration, photographs, and identification.

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    This document is an application form for the Aga Khan University Fellowship Programme submitted by Dr. Mansoor Ahmed Mazari. It provides his personal details such as name, date of birth, nationality, contact information, medical education history, residency details, qualifications, and a checklist of required documents to submit with the application. The form seeks information about his medical college, house jobs, residency program, qualifications like FCPS parts 1 and 2, PMDC registration, and other experience. It is endorsed by his supervisor/principal and includes a list of documents that must be attached like mark sheets, degrees, registration, photographs, and identification.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    10 views3 pages

    The Aga Khan University Fellowship Programme Application Form

    Uploaded by

    ShabanMazari
    This document is an application form for the Aga Khan University Fellowship Programme submitted by Dr. Mansoor Ahmed Mazari. It provides his personal details such as name, date of birth, nationality, contact information, medical education history, residency details, qualifications, and a checklist of required documents to submit with the application. The form seeks information about his medical college, house jobs, residency program, qualifications like FCPS parts 1 and 2, PMDC registration, and other experience. It is endorsed by his supervisor/principal and includes a list of documents that must be attached like mark sheets, degrees, registration, photographs, and identification.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    Photograph

    THE AGA KHAN UNIVERSITY


    Fellowship Programme Application Form

    Username/Email

    drmansoormazari@yahoo.com

    Speciality

    Paediatric Critical Care Medicine

    Name(as per CNIC)

    Mansoor Ahmed Mazari

    Father/Spouse name

    Muhammad Shaban Mazari

    Gender

    Male

    Date of Birth

    13-November-1980

    Nationality

    Pakistani

    CNIC

    45104-0264105-3

    Passport #
    Mailing Address

    Flat No.08, 47-I, Lawrance Road Lahore.

    Country

    Pakistan

    City

    Lahore

    State / Province

    Other (Non U.S.)

    Permanant Address
    Country
    City
    State / Province
    Cell #

    0332-4148945

    Fax #
    Home / Office Tel #

    0332-4148945

    Name of medical college attended

    Nishter Medical College

    Others
    Medical college graduation date

    April-2005

    House job institution name 1

    Services Institute of medical


    sciences/services hospital lahore.

    Duration

    July 2005-January 2006

    House job institution name 2

    Services Institute of medical


    sciences/services hospital lahore.

    Duration

    January 2006-July 2006

    House job institution name 3


    Duration
    House job institution name 3
    Duration
    Residency institution name

    Services Institute of medical


    sciences/services hospital lahore.

    Residency institution Address

    Jail Road Lahore

    Residency completion year

    2011

    Cleared FCPS - I

    Yes

    Year

    2007

    Cleared FCPS - II

    No

    Year
    PMDC Number
    PMDC Validity
    Other qualification

    Diploma child health

    Other experience
    AdmissionTest Centre
    Is your application complete

    No

    Pending documents

    PMDC Renewal

    Endorsement (should be attested by the Principal of the institute last worked at or


    professor of any medical college)
    I certify that the information given above is correct .
    ___________

    ___________

    ___________

    ___________

    Name and
    Designation

    Signature

    Official Stamp

    Date

    Following items are to be included with this application:


    [ ] Completed application form endorsed by supervisor/principal.
    [ ] Attested copies of mark sheets of all professional examinations.
    [ ] Attested copy of MBBS degree.
    [ ] Attested copy of provisional registration of PMDC.
    NOTE: All photocopies should be cut or minimised to A4
    [ ] Two passport size photographs:
    Taken one week prior to submission of this application.
    One attested and pasted on this application form and the other attested at the
    back for the Admit Card.
    Face should be clearly visible
    [ ] Copy of National Identity Card / Passport (page 1 & 2).
    [ ] Self-addressed envelope (4.5 x 8.5 inches).

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