MIDTERM EVALUATION
LIAQUAT UNIVERSITY OF MEDICAL AND HEALTH SCIENCES
JAMSHORO – SINDH – PAKISTAN
NOTE: This form is liable to be rejected if all entries regarding full name, subject terms, SEAT NO.
exemption etc are not fully and clearly mentioned and also on any other ground by the
university authorities at any stage before the commencement of Examination.
EXAMINATION FORM FOR MTE (MID TERM EVALUATION)
JANUARY/JULY Click here to enter text.
TITLE OF COURSE Click here to enter text.
I have paid Rs. ____________ /- (Rupees ______________________________________________________/-)
as Examination Fee Challan/Bank Draft No. _______________Dated: _________________
(Original Office Copy attached). Attach three
To Photographs
The Controller of Examination (PG)
Liaquat University of Medical & Health Sciences
Jamshoro, Sindh
Sir/Madam,
I request for permission to present myself at the ensuing MTE (Mid Term Evaluation) Examination in the
discipline of Click here to enter text. at LUMHS Center.
PERSONAL DETAILS
NAME Click here to enter text.
FATHER’S NAME Click here to enter text.
SURNAME Click here to enter text.
CNIC Click here to enter text. NATIONALITY Click here to enter text.
PASSPORT NO. (IN CASE OF FOREIGNERS) Click here to enter text. ISSUANCE DATE Click here to enter text.
RELIGION Click here to enter text. GENDER MALE FEMALE
ENROLMENT NO. Click here to enter text. ISSUANCE DATE Click here to enter text.
ELIGIBILITY CERTIFICATE NO. Click here to enter text. ISSUANCE DATE Click here to enter text.
ADDRESS Click here to enter text.
PHONE NO. Click here to enter text. MOBILE NO. Click here to enter text.
EMAIL ADDRESS Click here to enter text.
EXAMINATION PASSED SEAT NO. YEAR INSTITUTION UNIVERSITY
FINALPROF.MBBS Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.
OTHERMEDICALEXAMINATION Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.
If I am permitted to appear at the examination, I undertake to submit without demur or protest the decision of the Liaquat
University of Medical & Health Sciences, Jamshoro as far as the examination and its results are concerned.
I further do hereby declare that this form is in accordance with the provision of the Liaquat University of Medical & Health
Sciences, Jamshoro and the rules and regulation framed thereunder and in case any error or irregularity is detected in the
form at any stage before commencement of examination the form shall be liable to be rejected and I shall abide the decision.
DATED Click here to enter text. SIGNATURE OF THE CANDIDATE
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CERTIFICATE TO BE SIGNED BY THE
CONCERNED SUPERVISOR, CHAIRMAN/CHAIRPERSON AND
DIRECTOR POSTGRADAUTE MEDICAL CENTER LUMHS, JAMSHORO
1. I certify that Dr. Click here to enter text. S/O, D/O, Click here to enter text.
has attended 75% of Lectures / Practical and other classes in this institution required completed required for MTE.
2. Discipline in Click here to enter text.During the academic year Click here to enter text.
3. The date of admission in the course is Click here to enter text.
OR
1. The candidate had appeared at the MTE Discipline Examination in Click here to enter text.
2. January/July Examination in the year Click here to enter text. and failed.
3. Seat Number of candidate was Click here to enter text.
4. Certified that the candidate has complied with all the conditions, rules, regulations and instructions issued and the form
has been filled correctly and properly.
5. I also certify that the candidate is to the best of my knowledge, a person of good character and has my permission to
appear at the ensuring examination for MTE Examination.
6. Certified that the candidate has cleared all dues of PGMC LUMHS/Concerned Institution.
Signature & Stamp Signature & Stamp Signature & Stamp
CONCERNED CONCERNED DIRECTOR, PGMC
SUPERVISOR CHAIRMAN/CHAIRPERSON LUMHS JAMSHORO
DATED Click here to enter text.
IMPORTANT INSTRUCTIONS FOR FILLING UP THE EXAMINATION FORM
1. This form will be rejected if the entries regarding full name, subjects and other items of information are not clearly
mentioned in the form and if the required Documents are not provided in this form.
2. Form submitted after the prescribed date shall not be accepted.
3. Whatever is indicated in the form shall be considered as final.
4. The exemptions once exercised by a candidate shall be considered final.
5. All entries in the form should be made in BLOCK LETTERS.
6. Form should be thoroughly checked before it is forwarded to the Examination Department, Liaquat University of
Medical & Health Sciences, Jamshoro. The entries and responsibility for any eventual mishap at the Examination on
account of any inaccuracy or omission in the form shall be on the candidate.
7. The authorities of Liaquat University of Medical & Health Sciences shall not be responsible for any eventual mistake,
in the result of candidate, if the Form is not correctly filled in, and if there is any omission of subject / papers of the
material fact.
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