Mohi-ud-Din Islamic Medical College

Sector D-4, Mirpur (AJ&K)

Application Form (MBBS)
Session 2018-23

Name of Candidate: _____________________________________________________

NUMS Student ID ____________________ Merit List No. _____________________ Attach
recent
Fee Deposited Rs. ____________________ Date ______________________ passport size
photo
Name of Bank and Branch ________________________________________________
Bank Challan No _______________________________________________________

Date of Birth _____________ Age: ____________ Marital Status________________

Candidate Email ________________________________________________________

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#_____________________

 Educational Qualification
Please attach attested photocopies of the supporting documents

Degree/Certificate Institution Attended Board University Grade/Marks Year Passed

/Diploma

Selected on Seat
Open merit
Foreign/Dual National/ Overseas

Co- Curricular Activities

___________________________________________________________________________________________

___________________________________________________________________________________________
Hostel

I wish to reside in the College Hostel Yes No

If yes please fill in Hostel Application Form
Undertaking
I solemnly declare that the information provided in the application form and documents attached with application
form are correct and no information asked has been concealed. The provision of incorrect information/document will
disqualify me for admission or continuation of my studies at Mohi-ud-Din Islamic Medical College.
Candidate’s Name __________________________________ Signature_____________________________
Father’s Name: _______________________________________Signature ____________________________

Date: ____________________________
Requirements
Please attach attested copies of the following documents:
1 -Matriculation Certificate
2 -F. Sc. (Physics, Chemistry, Biology) [Minimum of 60% marks] (For foreign, dual nationality holders or
overseas Pakistani candidates: Chemistry, Biology and either Physics or Mathematics with 60% in
aggregate certified by IBCC is mandatory
3- Domicile Certificate 4– CNIC / Form B 5- Photograph (8) passport size
6- Copy of mark sheet of entry test (Provincial/Govt)

Mailing Address

Registrar, Principal,
Mohi-ud-Din Islamic University, Mohi-Ud-Din Islamic Medical College,
Camp Office Union Council Road, Industrial Area, Mirpur,
Sihala, Islamabad, AJ&K. Ph #: +92-5827-468159
PAKISTAN. Ph #: +92-51-4485831-2,