PAKISTAN NURSING COUNCIL,

National Institute of Health, Park Road, Chakshehzad,

Islamabad, Pakistan
Phone No. 051-9255804 ext-105, Fax No. 051-9255813
Website: www.pnc.org.pk Email: preregistration@pnc.org.pk
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P R E R E G I S T R A T I O N
E N R O L L M E N T F O R M
FOR SCHOOL / COLLEGE OF NURSING Past here recent
passport size
SESSION 2023 to 2024 . photograph

INSTITUTION FAROOQ MEMORIAL INSTITUTE .

SECTION-I

Student’s Full Name: ____FARZANA _______________________________________

Daughter of / Wife of / Son of GHULAM AHMAD__________________________ ____

Nationality: PAKISTANI_______________________ Religion ISLAM__________ _____

Province of Domicile: KHYBER PAKHTUNKHWA __________________________ _____

Permanent Address: HOUSE NO 12/1 BLOCK 173 MUHALLA RAILWAY COLONY _ _

PESHAWAR CANTT_____________________________________________________________

__________________________________________________________________________

Date of Birth. 1st AUGUST 1978_________________ Contact # 03121247104______________

CNIC # 1 7 3 0 1 7 4 6 2 7 1 8 0 Passport No. NIL_____________

(for foreigners only)

SECTION-II
Qualification Passing Marks % age of Marks Board
Year Obtained/Total Marks Marks Obtained
in Biology
/Total
Marks
Matriculation 1992 398 47% --- PESHAWAR
 Page-2
SECTION-III
Course in which enrollment is desired
S.No. Diploma / Degree Period Educational Institute
From To (E-mail / contact number)

1. POST RN BSN 2023 2024 info@fminahs.edu.pk

+92-314-5377531

SECTION-IV
In which type of Institution are you enrolled (tick the box where applicable)
 School of Midwifery  School of Public Health  School of Nursing
 College of Nursing (BSN, MSN, Post RN BSN, PhD)
 Other (specify) _____________________________________________________

SECTION-V
Ever register with PNC: Yes q No q
If yes, specify your PNC Registration #: A-39456_________________ Date: 05-06-23_____
Valid up to

SECTION-VI
Present employment is with: (tick the box where applicable)
Government q Private q Semi Government q Armed Forces q NGO q

SECTION-VII
What is your present position / designation at workplace?
_HEAD NURSE____________________________ _______________________
(specify your designation)
_LADY READING HOSPITAL, PESHAWAR, KPK________________________
(Address of workplace)

SECTION-VIII

I hereby certify that the information contained in this application is true and correct?

________________________
Certify by
Principal – College/School of Nursing
_________________________ Applicant Signature
Date (Please sign inside the box without touching lines)