Form No: ---------------
Roll No: -------------(Office use only)
UNIVERSITY OF HEALTH SCIENCES LAHORE
Khayaban-e-Jamia Punjab, Lahore
Ph. No.(Off) 042-9230395 (6 lines) , Fax:No.042-9231857
Admission Form for MBBS Program
NOTE: The form shall be submitted to the Office of the Controller of Examinations. The name/spelling of the candidate and his/her father be correctly written on this form, exactly as per the Matric/Equivalence Certificate, because, the same spelling /name will be finally printed on the Degree issued to you by the University. Please fill in the form in black ink and clearly print or type only in CAPITAL letters and avoid contact with the edges of the boxes. A box may be left empty wherever a word ends and a new word begins in the same line or where nothing further is to be written. Avoid any over-writing and other mistakes while filling in the form. Please make sure the form is filled in as neatly as possible. Admission form shall be filled in legibly and correctly by the candidate in his/her own handwriting. Incomplete and incorrect admission form may be cancelled. The University shall not take any responsibility for the consequences. Wherever small choice field boxes are provided in the form, the box adjacent to the appropriate answer is to be ticked or crossed. Or Please affix photograph here attested from front side (3X3 cm) with blue background
1 0
Admission form for:
First Professional Part-I Third Professional
First Professional Part-II Final Professional
Second Professional
APPLICANTS PERSONAL INFORMATION
2 0
Full Name (first, middle, last)
3 0 4
Fathers Name (first, middle, last)
Applicants NIC
Name of Institution
5 0
Registration Number
6 0 8 0 9
Nationality:
- U
Mailing Address (mention all relevant information like post code etc.) .. Mobile/ Telephone Number (with city code)
E-mail / Fax #
10
Page 1
11
Appearing as Fresh / Repeater If Repeater, Number of attempts already made (excluding this attempt): Previous appearances: First Attempt Second Attempt Third Attempt Fourth Attempt ----------------: : : : Annual / Supplementary 200 .. Annual / Supplementary 200 .. Annual / Supplementary 200 .. Annual / Supplementary 200 .. -----------------------------Roll No Roll No Roll No Roll No
--------------------
12
Subjects in which to be examined: 1. 2. 3. 4. 5. 6.
------------------------------------------------------------------------------------------------------------Mode of Payment
---------------------------------------------------------------------------------------------------------------Bank Receipt /
13
Fee Paid Rs.
Draft (DD
Draft/Bank Receipt No: ______________________ Date:
MM / YYYY)
NOTE: Attach original Bank Draft/Bank Receipt with this form Documents to be attached I have attached attested copies of the following documents with this form: Certificate of F.Sc (Only for 1 Prof. MBBS Part-I) 03 photographs size (3x3 cm) paste at given place and 01 photograph size (3x3 cm) (attested from back side) attach with admission Form. Migration Certificate (in case of migration only)
st
14
DMC of Previous Professional Examination
15
CERTIFICATE BY THE APPLICANT I hereby solemnly declare that: (1) the information provided and statements made by me in this form are true and correct to the best of my knowledge and belief and nothing has been concealed or withheld herein. (2) I shall be responsible if my application form is rejected for any errors, misinformation or incomplete entries made by me. (3) I understand that applying for examination without being eligible for it is a crime punishable under law, and in such case, the university has every right to cancel my result.
Date: _____________________
_________________________
Signature of the applicant
16
CERTIFICATE BY THE PRINCIPAL A certificate on a pattern provided below will be sent to the Examination Department no later than two weeks prior to the commencement of the examination. Other wise Roll # slip / Admittance card shall not be issued to their candidates.
{I certify that the candidate is eligible in all respects as per Rules & Regulation of PMDC & University of
Health Sciences, Lahore to appear in this examination.
Dated: _____________________ ____________________________ } Signature of Principal (with stamp)
Page 2
UNIVERSITY OF HEALTH SCIENCES Lahore
Roll NO SLIP
(FOR SUPERINTENDENT)
Roll No :
_______
(Office use only)
Examination: _____________________________________________ Name: _____________________________________________ Fathers Name: ___________________________________________ Name of Institution: ________________________________ Subjects in which to be examined: ____________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
examination centre. ______________________
Please Paste photograph here attested from front side (3X3 cm) with blue background
Controller of Examinations
Note: Cell/mobile phones, palm tops, minicomputers and any other electronic equipment likely to help the candidates are completely prohibited in the
Signature of the Candidate
UNIVERSITY OF HEALTH SCIENCES Lahore
ROLL NO SLIP
(FOR CANDIDATE TO BE HANDED OVER TO THE SUPERINTENDENT)
Roll No :
_______
(Office use only)
Examination: _____________________________________________ Name: _____________________________________________
Please Paste photograph here attested from front side (3X3 cm) with blue background
Fathers Name: ___________________________________________ Name of Institution: ________________________________ Subjects in which to be examined: ____________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
examination centre.
Controller of Examinations
Note: Cell/mobile phones, palm tops, minicomputers and any other electronic equipment likely to help the candidates are completely prohibited in the
______________________
Signature of the Candidate
Page 3
