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Admission Form Professional Institute of Medical Science Peshawar, Khyber Pakhtunkhwa

This document is an admission form for the Professional Institute of Medical Science in Peshawar, Khyber Pakhtunkhwa. [1] The form requests information for admission such as the applicant's name, father's name, date of birth, address, contact details, academic qualifications and signatures. [2] The applicant must also select their department of choice from options including pharmacy, anesthesia, dental, surgical and pathology. [3] Documents including academic transcripts, domicile certificate, character certificate and CNIC copies must be attached with the completed form.

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saeedullah afridi
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69 views1 page

Admission Form Professional Institute of Medical Science Peshawar, Khyber Pakhtunkhwa

This document is an admission form for the Professional Institute of Medical Science in Peshawar, Khyber Pakhtunkhwa. [1] The form requests information for admission such as the applicant's name, father's name, date of birth, address, contact details, academic qualifications and signatures. [2] The applicant must also select their department of choice from options including pharmacy, anesthesia, dental, surgical and pathology. [3] Documents including academic transcripts, domicile certificate, character certificate and CNIC copies must be attached with the completed form.

Uploaded by

saeedullah afridi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ADMISSION FORM

Professional Institute of Medical Science


Peshawar, Khyber Pakhtunkhwa
S.No. _____________ Registration No._________________________

1. Select any Departments/disciplines on Priority Basis for Admission from the following List:

i. Pharmacy ii. Anesthesia


iii. Dental iv. Surgical
v. Phatology

2. NAME OF APPLICANT (In Block Letters):________________________________________________________________


3. FATHER’S NAME (In Block Letters): _____________________________________________________________________
4. DATE OF BIRTH: (In fig)_______________ (In words) _______________________5. DOMICILE: ______________
6. GENDER: _______________________________7. APPLICANT’S CNIC No:_______________________________________
8. FATHER’S CNICNo:_____________________________________________________________9. BLOOD GROUP:______
10. NATIONALITY: _______________________11. FATHER’S OCCUPATION: ___________________________________
12. RELIGION: __________________________ 13. ADDRESS: ______________________________________________________
__________________________________________________________________________________________________________________
14. PHONE NO: __________________________15. CELL NO: _______________________16. E.MAIL:__________________

ACADEMIC QUALIFICATIONS
Certificate/ Board/ Year of Annual/ Roll No Marks Total %age
Degree University Passing Supply obtained Marks
Metric
(SSC)
Inter
(HSSC)
UNDERTAKING
I hereby certify that the information provided in this application form is correct. I undertake
to abide by the rules and regulations of the Shaheed Benazir Bhutto University and the orders
issued by the competent authorities from time to time. I also submit that my admission in the
University is provisional and is subject to cancellation if any irregularity is found in my
admission Form / Documents /Conduct etc at any stage.

_______________ _______________________
Applicant’s Signature Father’s / Guardian Signature

Documents (Attested photocopies of) to be attached with the Admission Form:


(1) (DMCs) (2) Provisional (3) Domicile (4) Character Certificate (5) CNICs of the Applicant,
Father/ Guardian.
………………………………………………………………………………………………………………
For Office use only
Admission Committee:
1__________________________2______________________________3_____________________________4_____________________________

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