College of Physicians & Surgeons Pakistan
7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606
Website: www.cpsp.edu.pk
Term: 25-FEB-2015
Online Application Form For FCPS-II (MAJOR SUBJECTS)
Appearing In:
Theory
Fee Type:
Fee Submission City
Receipt #:
Bank Name:
Branch Name:
Bank Challan
Fee Amount:
Karachi
KHI-C-14-6959
Receipt Date:
UNITED BANK LTD
Sunset Boulevard Branch, Karachi (1620)
PKR 15050
28-10-2014
Profile Information
CPSP ID:
Medical Reg. No:
PMDC Issue/Exp. Date:
2010-3135
55836-S
03-06-2009 ---- 31-12-2018
Full Name:
Father's Name:
ANEELA REHMAN
ABDUL REHMAN
Nationality:
Identity Card No:
Date of Birth:
Email:
Gender / Marital Status:
Pakistan
42501-2966906-6
10-03-1984
[email protected]
Female / Single
Form No:
698-29237
Repeater
Karachi
OBSTETRICS AND
GYNAECOLOGY
OBG-2010-183-4634
Present/Mailing Address (Residential Only)
Address:
Tel (Res.):
Cell:
H/NO. H-8/3-4 STEEL TOWN
Karachi, Sindh, Pakistan
021-34157594
03312652689
Tel (Office):
Postal Code:
Permanent Address (Residential Only)
Same as Mailing Add:
Address:
Tel (Res.):
Cell:
Yes
H/NO. H-8/3-4 STEEL TOWN
Karachi, Sindh, Pakistan
021-34157594
03312652689
Tel (Office):
Postal Code:
Particulars of Last Examination Appeared
Roll Number:
Enrolment:
12103
Date of Examination:
Center:
27-08-2014
Karachi
Declaration
I do hereby declare that information given above is correct to the best of my knowledge. Incorrect information may lead to cancellation of enrollment /
admission / results and disciplinary action.
Signature of Candidate: ________________________________
Dated: 28-10-2014
Name: ANEELA REHMAN
Note:
For quick and effective communication all correspondence with the candidates will be done through email rather than by postal means / courier.
Overwriting is not allowed on the hard copy of the application form nor any candidate is allowed to change his/her particular electronically.
Once entered in the application the center will only be changed after submission of prescribed fee fo this change.
Candidates are advised to attach a hand written application if they want to change their particulars.
If you have any problem then contact at this number: 021-99207100 Ext. 246 or email at [email protected].
page 1 / 3
ORIGINAL
DUPLICATE
- Concerned Department
Branch: Sunset Boulevard Branch, Karachi (1620)
Account #: 100-4666-8
Branch: Sunset Boulevard Branch, Karachi (1620)
College of Physicians and Surgeons Pakistan
Karachi
Receipt #:
KHI-C-14-6959
Name:
ANEELA REHMAN
Account #: 100-4666-8
College of Physicians and Surgeons Pakistan
Bank Challan
Center:
- Applicant
Bank Challan
RTMC No: OBG-2010-183-4634
Receipt Date: 28-10-2014
Center:
Karachi
RTMC No: OBG-2010-183-4634
Receipt #:
KHI-C-14-6959
Name:
ANEELA REHMAN
Receipt Date: 28-10-2014
Form No: 698-29237
Fee Type
Exam Fee - FCPS-II
Total:
Amount in words: Fifteen Thousand and Fifty Only
____________________________
Candidate / Depositor Signature
Contact No: ________________
Form No: 698-29237
Session
Amount
FEB-2015
PKR 15050
Exam Fee - FCPS-II
PKR 15050
Total:
(PKR)
____________________________
Receiver's Signature
Fee Type
Session
Amount
FEB-2015
PKR 15050
PKR 15050
Amount in words: Fifteen Thousand and Fifty Only
____________________________
Candidate / Depositor Signature
(PKR)
____________________________
Receiver's Signature
Contact No: ________________
page 2 / 3
TRIPLICATE
Branch: Sunset Boulevard Branch, Karachi (1620)
QUADRUPLICATE
- CPSP Finance
Account #: 100-4666-8
Branch: Sunset Boulevard Branch, Karachi (1620)
College of Physicians and Surgeons Pakistan
Karachi
Receipt #:
KHI-C-14-6959
Name:
ANEELA REHMAN
Account #: 100-4666-8
College of Physicians and Surgeons Pakistan
Bank Challan
Center:
Bank Challan
RTMC No: OBG-2010-183-4634
Receipt Date: 28-10-2014
Center:
Karachi
RTMC No: OBG-2010-183-4634
Receipt #:
KHI-C-14-6959
Name:
ANEELA REHMAN
Receipt Date: 28-10-2014
Form No: 698-29237
Fee Type
Exam Fee - FCPS-II
Total:
Amount in words: Fifteen Thousand and Fifty Only
____________________________
Candidate / Depositor Signature
Contact No: ________________
- Bank
Form No: 698-29237
Session
Amount
FEB-2015
PKR 15050
Exam Fee - FCPS-II
PKR 15050
Total:
(PKR)
____________________________
Receiver's Signature
Fee Type
Session
Amount
FEB-2015
PKR 15050
PKR 15050
Amount in words: Fifteen Thousand and Fifty Only
____________________________
Candidate / Depositor Signature
(PKR)
____________________________
Receiver's Signature
Contact No: ________________
page 3 / 3
