Social Security Teaching Hospital, Lahore

APPLICATION FORM

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Form No.: 2400000978 (08/06/2024 11:03 AM) Received/Verified By: _________________

GENERAL
Discipline Type: MCPS
Discipline Applied For: DIAGNOSTIC RADIOLOGY
PMDC No: 714213-01-M
Closing Date: 10/06/2024
PERSONAL RECORD
Candidate´s Name: Shahzad Azam CNIC: 32303-4561318-5
Father’s Name: Malik Muhammad Azam D.o.B: 23/06/1997
CNIC Expiry: 2026-12-20 PMDC 18/06/2024
Expiry:
Religion: Islam Gender: Male
Cell No.: 03486972685 Office No.: 03127481497
Email: shahzadazam685@gmail.com Nationality: Pakistani
Province: Punjab District: Muzaffargarh
Martial Status: Married Domicile: Muzaffargarh
Permanent Address: Post Office Qasba Gujrat Tehsil Kot Adu District Muzaffargarh
Postal Address: Post Office Qasba Gujrat Tehsil Kot Adu District Muzaffargarh
MBBS Degree From: Pakistan
MBBS Degree Yes
recognized by the
PMDC:

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1. ACADEMIC QUALIFICATION:
Degree Level/ Board/University Year Roll No./ Marks/
Title Reg No. GPA
Matriculation BISE DG Khan 2013 225155 892/1050

Matric 8-1-137665-11

Intermediate BISE DG Khan 2015 408941 716/1100

Intermediate 0813323232378

MBBS Part-1 Liaqat University OF MEDICAL AND HEALTH SCIENCE Jam 2017 15MM467 790/1200

Mbbs shoro Sindh Pakistan MMC/PR/85

No Of Attempts: 1

MBBS Part-2 Liaqat University OF MEDICAL AND HEALTH SCIENCE Jam 2018 15MM467 779/1200

Mbbs shoro Sindh Pakistan MMC/PR/85

No Of Attempts: 1

Position: 2

MBBS Part-3 Liaqat University OF MEDICAL AND HEALTH SCIENCE Jam 2019 15MM467 706/1200

Mbbs shoro Sindh Pakistan MMC/PR/85

No Of Attempts: 1

Position: 2

MBBS Part-4 Liaqat University OF MEDICAL AND HEALTH SCIENCE Jam 2020 15MM467 768/1200

Mbbs shoro Sindh Pakistan MMC/PR/85

No Of Attempts: 1

Position: 2

MBBS Part-5 Liaqat University OF MEDICAL AND HEALTH SCIENCE Jam 2021 15MM467 1214/1800

Mbbs shoro Sindh Pakistan MMC/PR/85

No Of Attempts: 1

2. SERVICE / EMPLOYEMENT RECORD

Experience Type Designation Institution From Date To Date
House Job Nishtar Hospital Multan 13/06/2021 14/06/2022

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 DECLARATION AND SIGNATURE

I hereby declare that all the information and statements made in the application are complete, true, and correct to the
best of my knowledge and belief. In the event of my information being found false or incorrect or I am detected
ineligible before or after the selection, I am liable to cancel my candidature/selection.

(Signature of the Applicant) (Date)

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 CHECK LIST
CHECK LIST FOR THE SUBMISSION OF DOCUMENTS FOR FCPS PART II/MCPS
1. Printed Application Form downloaded from Web-Portal (Candidate Signed)
2. Passport Size Photograph (Attach on the Front page of Application Form)
3. Computerized National Identity Card (Valid)
4. Registration of PMC/PMDC (Valid)
5. Matriculation Certificate (Science Group) Or equivalent
6. Intermediate Certificate (Pre-Medical) Or equivalent
7. Detail of Marks of all Professional Exam of MBBS/ Consolidated Mark Sheet for Foreign Graduates
8. MBBS Degree
9. FCPS Part-I Completion (Pass) Certificate (Compulsory) (Only For FCPS)
10. Attempt Certificate (MBBS) (For Local University Graduates)
11. Experience Certificate of Primary, Secondary or Tertiary Healthcare Level (If Any)
12. University Level Position Certificate issued by competent authority (If Any)
13. Complete House Job Certificate (01-Year)
14. Domicile (Punjab Only)
15. No Objection Certificate issued by competent authority (For Government/ Semi-Government/ Autonomous
Body Employees)
16. Special Person (Disability) Certificate (If Any)
NOTE:
Please arrange all the above mentioned documents according to the check list and tag in office file before
submission.

Cut the postal address written below the line and paste on your Courier Envelope

POSTAL ADDRESS FOR INDUCTION APPLICATION

Social Security Teacing Hospital, Lahore
Multan Chungi, Multan Road, Lahore. (042) 99330029

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