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APPLICATION FORM - SESSION 2014-15

FOR ADMISSION IN 1
ST
YEAR MBBS (Foreign Seat)
Please fill in capital letters, Write N.A., where not applicable.



A. PERSONAL INFORMATION

1. Applicants Name NIC#/Form B
(with correct spelling as per SSC Certificate)

2. Fathers Name NIC#
(with correct spelling as per SSC Certificate)

3. Fathers Occupation Father/Guardian Annual Income

4. Date of Birth / / Place of Birth Sex: Male / Female

5. Nationality 6. Religion

7. Marital Status: Married / Unmarried If Married, SPOUSE Name

8. Present Postal Address



9. Permanent Home Address



Contact Mobile Land Line Email
Personal
Father
Guardian
Residence

B. ACADEMIC RECORD

Examination Passed
Year of
Passing
Annual/
Supply
Marks
Obtained
Total
Marks
Div./ Grade/
percentage
Name of School / College
Name of
Board
1. Matric/Equivalent

2. F.Sc. /Equivalent
(Pre-Medical)

3. Provincial Entry
Test of Medical
Colleges
Roll No. Attempt No.
Marks
Name of Province
Obtained Total



How many paaras of the Holy Quran have you memorized? _______ (Attach the Hifz Certificate)

PMC Roll No.___________
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Name of Guardian/Financial Supporter (if any)

Relation with applicant

Address of the Guardian / Financial Supporter



C. OTHER ATTRIBUTES

Out standing Academic Achievements (if any):





Scholarships won (if any)

Any outstanding achievement in Extra Curricular activities:

_______________________________________________________________________________





Computer Skills (If any please give details)

D. WILL YOU NEED A SEAT IN HOSTEL? YES_____ NO _____

E. DECLARATION

I declare that all entries / statements given in this form are correct to the best of my
knowledge. If any statement is found false / incorrect, College authorities have the right to
terminate the admission. I will abide by the decision / action of the College authorities. I
declare that I can afford all the education expenses.



Applicants Signature: Father/Guardians Signature:


Date____________________ Date____________________
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F. GENERAL INSTRUCTION

1. Photocopies of the following documents should be attached with the application.

a. SSC (Matric) / equivalent Certificate and DMC (Provisional Certificate is not acceptable)
b. F Sc / equivalent Certificate and DMC.
c. Two recent passport size photographs.
d. NIC / Form B
e. Father / Mother NIC
f. ETEA Certificate
g. Hifz Certificate (if applicable)
h. Overseas Sponsorship Certificate (if applicable)

2. Original Documents shall be required at the time of interview.


FOR OFFICE USE ONLY

Aptitude Assessment / Interview Marks:

Provincial Entry Test Marks:

Hafiz e Quran Marks: (total marks: 20 per paara 0 .67)

Final Result:


Admitted: Not Admitted:




___________________________
Chairman Selection Committee