GOVERNMENT OF PAKISTAN
ALLIED HEALTH PROFESSIONALS COUNCIL
Ex. PHRC Building, Shahrah-e-Jamhuriat, Opp. Radio Pakistan,
Sector G-5/2, Islamabad.
Ph: (051) 9216775; 9217146; 9207386 Ext. 20
REGISTRATION FORM-E
APPLICATION FOR THE CERTIFICATE OF Paste your
recent
GOOD STANDING
Passport Size
Photo
Registration No. ____________________
Name of Professional: ________________________________________________________________
Father's Name: _____________________________________________________________________
Fee Deposit Slip No: ____________ Date: ____________ Amount: ________________
(Fee Rs. 3000/- Non-refundable / Non- Transferable)
CNIC: ___________________________ Date of Birth: DD____ MM ____ YYYY______
Passport No: ___________________ Email:________________________________________________
NICOP (if applicable) : ________________________________Gender: ___________
Postal Address: ______________________________________________________________________
Name of the country / place abroad applying for: __________________________________________
Declaration: By signing below, I solemnly declare that the above provided information is true according to best of my knowledge
and believe and there is nothing kept hidden from the authority. If any information / act found false / objectionable, at later stage
the Council reserves the right to take legal action against me.
Signature of Applicant
FOR OFFICE USE ONLY
Decision: Approved Revision Required Not Approved
Registration issued upto:
from: DD ____ MM____ YYYY_______ to: DD ____ MM____ YYYY_______
Remarks (if any): ___________________________________________________________________________
Signature & Stamp of Authorized Officer
