Application Form

(MBBS Session 2010-2011)

Name of Applicant: _____________________________________________________

Date of Birth: _____________ Age: ____________ Marital Status________________ Attach recent passport size
photo
Father’s Name: ________________________________________________________

Father’s Profession: ____________________________________________________

Designation: _________________________________________________________

Office/Business Address: ____________________________________________________________________________

_________________________________________________________________________________________________

Phone Office: ____________________________ Fax: ___________________________ Mobile: __________________

Present Mailing Address of Parents: ___________________________________________________________________

_________________________________________________________________________________________________

Phone Res: ____________________________ Fax: ___________________________ Mobile: ____________________

Permanent Address: ________________________________________________________________________________

_________________________________________________________________________________________________

Nationality of Candidate: _________________________ NIC/Form B #: ______________________________________

Passport # (Foreign /Expatriate Students):________________________________________________________________

Name of Guardian (If other than father):_________________________________________________________________

Occupation of Guardian:_________________________________ Phone#: ___________________Fax#______________

Email: ____________________________________________________________________________________________

Educational Qualification
Please attach photocopies of the supporting documents

Degree/Certificate/ Institution Board/university Grade/ Year

Diploma attended marks Passed
Option for Seat:

 Open merit 60
 AJ&K Government Nominees 20
 Expat – Pakistani Oversees/Foreign Student 20

Extra Curricular Activities

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Hostel

I wish to reside in the College Hostel Yes ( ) No ( )

Signature of Applicant

Name: ____________________________________________________________________________________________

Father’s Name: ____________________________________________________________________________________

Requirements: Please attach attested copies of the following documents:

1 - Matriculation Certificate
2 - F. Sc. (Physics, Chemistry, Biology) [Minimum of 60% marks] (For Oversees Pakistani & Foreigners,
Chemistry and Biology is compulsory with SAT – II, 5.50 score is a must)
3 - Domicile
4 - CNIC
5 - Photograph (8) passport size
6 - Application & Processing Fee of RS. 2500/-(For Local Candidates) and $ 50 for Foreign and Overseas
Candidates in the shape of Demand Draft in the name of Mohi-Ud-Din Islamic University, Islamabad

Mailing Address
Registrar,
Mohi-ud-Din Islamic University,
Plot # 2 – A, Near PSO Petrol Pump,
I-9 Markaz, Islamabad,
PAKISTAN.
Ph #: +92-51-4859658-9,
Fax #: +92-51-4859657

Principal,
Mohi-Ud-Din Islamic Medical College,
Industrial Area, Mirpur,
AJ&K.
Ph #: +92-5827-468666, 468155
Fax #: +92-5827-468777