APPLICATION FORM
FOR ADMISSION IN MEDICAL INSTITUTIONS IN SINDH
ACADEMIC SESSION 2003-2004
(TO BE FILLED IN BY THE APPLICANT AFTER READING THE INSTRUCTIONS GIVEN
ON PAGE VII CAREFULLY. THIS PAGE IS TO BE FILLED IN BLOCK LETTERS ONLY.)
NAME ____________________________________MALE/FEMALE
FATHER’S
NAME______________________________________________________
(GUARDIAN’S NAME, address & relationship with candidate)
___________________
PERMANENT ADDRESS_______________________________________________
_____________________________________________________________________
PRESENT POSTAL ADDRESS______________________________________-
_____
_____________________________________________________________________
PHONE NOs._________________________________________________________
REQUIRING ADMISSION FOR WHICH COURSE_________________________
(Write MBBS or BDS as the case may be)
DATE OF BIRTH______________________ DISTT. OF
DOMICILE____________
DOMICILE CERTIFICATE NO.________________DATE OF
ISSUE____________
P.R.C. NO._____________________ DATE OF ISSUE
________________________
INTERMEDIATE SCIENCE (Pre-Medical) PASSED IN
YEAR__________________
(or Equivalent Examination)
SEAT NO._____________ EXAMINATION CENTRE_______________________
DIVISION/GRADE____________________________________________________
TOTAL MARKS
OBTAINED_____________________________________________
MATRICULATION EXAM. PASSED IN
YEAR______________________________
(or Equivalent Examination)
SEAT NO._______________ EXAMINATION
CENTRE______________________
DIVISION/GRADE____________________________________________________
TOTAL MARKS OBTAINED____________________________________________
HIFZ-E-QURAN CERTIFICATE_________________________________________
(Write “Nil” if not available)
DATE OF ISSUE______________ NAME OF
INSTITUTION__________________
PLACE _______________ _________________________________
DATE ________________ SIGNATURE OF
APPLICANT
OPTION
I hereby give my option for admission in the following medical
institutions in Sindh and Colleges outside the province (Punjab) for
reciprocal / Merit Cum Choice seats in order of preference:- (DO
NOT USE ABBREVIATIONS / SHORT FORMS).
1.____________________________ 2.__________________________________
3.____________________________ 4.__________________________________
5.____________________________ 6.__________________________________
7.____________________________ 8.__________________________________
9.____________________________ 10._________________________________
This option once given shall be final. The Government shall
however consider this option only according to merit as per rules laid
down in the admission policy. Overwriting is not acceptable unless
full signature of the candidate is given on the overwriting.
_____________________________
________________________
Signature of the Father or Guardian Signature of
the candidate.
NAME:_____________________ NAME:___________________________
DECLARATION BY THE CANDIDATE:
THIS IS TO CERTIFY THAT I HAVE READ THE RULES AND
REGULATION MENTIONED IN THIS FORM AND THE PROSPECTUS
AND AGREE TO ABIDE BY THEM. I ALSO HEREBY AGREE THAT IF
ADMITTED, I SHALL CONFORM TO ALL PRESENT RULES,
REGULATIONS AND ORDERS IN FORCE IN THE MEDICAL
INSTITUTION INCLUDING THOSE THAT MAY BE MADE HEREAFTER
FOR THE ADMISSION TO THE INSTITUTION. I UNDERTAKE THAT SO
LONG AS I AM A STUDENT OF THE INSTITUTION I WILL DO NOTHING
EITHER WITHIN OR OUTSIDE THE INSTITUTION PREMISES THAT
MAY INTERFERE WITH ITS ORDERLY ADMINISTRATION AND
DISCIPLINE, OR MAY BRING THE INSTITUTION OR ITS
ADMINISTRATION INTO DISPUTE. I FURTHER UNDERTAKE THAT IF I
FAIL TO OBSERVE THE DISCIPLINE OF THE INSTITUTION I CAN BE
EXPELLED OR PUNISHED IN ANY OTHER WAY BY THE PRINCIPAL &
HEAD OF THE INSTITUTION AT ANY TIME DURING THE COURSE OF
MY STUDENT CAREER AT THE INSTITUTION.
_______________________________
Place________________ SIGNATURE OF APPLICANT
Date:________________ NAME:___________________________
SOLEMN AFFIRMATION BY PARENT OR GUARDIAN
(Note: Guardians may sign this declaration only if the parents are
not alive)
I,__________________________________________________ FATHER/GUARDIAN OF MR./
MISS. _____________________________ AN APPLICANT FOR ADMISSION TO THE
MEDICAL INSTITUTION DO HEREBY SOLEMNLY AFFIRM THAT ALL
STATEMENTS OR PARTICULARS MADE IN THE ABOVE APPLICATION ARE
TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AM AWARE THAT IF
ANY OF THE STATEMENTS MADE IN THE ABOVE APPLICATION IS FOUND
TO BE WRONG, MY SON, DAUGHTER OR WARD WOULD BE LIABLE TO BE
REFUSED ADMISSION IN THE INSTITUTION EVEN IF OTHERWISE ELIGIBLE,
AND IF ADMITTED WOULD BE LIABLE TO EXPULSION FROM THE
INSTITUTION AT ANY TIME DURING THE COURSE OF HIS OR HER STUDIES,
IN WHICH CASE, FEES AND OTHER DUES PAID BY HIM OR HER AT THE
TIME OF EXPULSION SHALL BE FORFEITED. FURTHERMORE, SUCH A
WRONG OR FALSE STATEMENT WOULD MAKE ME, MY SON, DAUGHTER OR
WARD LIABLE TO ANY FURTHER DEPARTMENTAL OR LEGAL ACTION,
WHICH THE GOVERNMENT MAY DEEM NECESSARY.
___________________________________
Place________________ SIGNATURE OF
PARENT/GUARDIAN
Date:________________ NAME:____________________
PARTICULARS OF FATHER/GUARDIAN OF APPLICANT
1. Full name of the
applicant_____________________________________________
2. Father’s Name (state whether alive or
dead)________________________________
3. Guardian’s Name and exact relationship (in case father is not
alive)__________________________
__________________________________________________________________
4. Occupation of father/guardian with
designation_____________________________
5.
Religion_____________________________________________________________
__
6. Permanent Home
Address______________________________________________
7. Present address
______________________________________________________
8. Telephone No. (if any) Residence ______________________ Office
________________________
9. Annual Income of
Father/Guardian_______________________________________
Date:_________________ ____________________________________
SIGNATURE OF FATHER
OR GUARDIAN
FULL NAME:__________________________
ACADEMIC RECORD OF APPLICANT
Examination Month Annual/ Name of Division/ Total
and Year Supplement School/ Grade Marks
ary
Passing College. obtained.
1. Matriculation
or equivalent
Examination.
2. Intermediate
Science
(Pre-Medical)
or Equivalent
Examination.
3. Any Other Exam.,
____________________________________
Place_______________ SIGNATURE OF
APPLICANT
Date _______________
Name:________________________
CERTIFICATE FROM HEAD MASTER/MISTRESS OF SCHOOL (last
attended)
This is to certify that Mr./Miss
______________________________son/daughter of Mr.
__________________________ was a student of this school having been
admitted into ___________ class from ___________
till_______________________.
The following are the particulars as entered in School
Register:
Name and Father’s
Name_________________________________
Permanent Address _____________________________________
Date of Birth __________________________________________
Last Examination Passed ________________________________
(a) Seat No.______________
(b) Enrolment No._________________
(c) Total Marks obtained_____________
(d) Division/Grade obtained ____________
It is further certified that during his/ period of stay in school his/her
conduct and character were ______________________ satisfactory
________________.
Place___________________ SIGNATURE OF
THE
Date:___________________ HEAD
MASTER/MISTRESS
WITH SEAL
CERTIFICATE FROM PRINCIPAL OF THE COLLEGE (LAST ATTENDED)
By the Principal of
_____________________________________________________ College
______________________________________________________________. This
is to certify that Mr./Miss _________________________________________
son/daughter of Mr.______________________________________ was a
student of that College having been admitted into
_________________Class from____________ ____________ till _____________
on the ____________________.
The following are the particulars of the student in accordance with
the official record maintained in the office of this college: -
(1) Name and father’s name ________________________
(2) Permanent Home Address (Village, Taluka and
_____________Distt.)
(3) Intermediate Science Examination of Board/University.
(a) Date of passing ______________
(i) Seat No. ______________
(ii) Enrolment No. ______________
(b) Subjects
(i) Physics.
(ii) Chemistry.
(iii) Biology.
(iv) Languages (a) English (b) _______________
(c) Division/Grade ______________ Total Marks
_______________
(d) No. of attempts at which passed _______________
(e) Whether received any punishment during the time
he/she was student of the college, if so, give details.
Particulars _________________
It is further certified that during his/her period of stay in this college
his/her work, conduct and character were ________________.
_________________________________________
Place________________ SIGNATURE OF THE PRINCIPAL WITH
SEAL
Date________________
FOR OFFICE USE ONLY
Intermediate science marks
______________________________________________
Addition of marks for Hafiz-e-
Quran_______________________________________
Deduction of marks ___________________for extra
attempts___________________
Marks added __________________________Marks deducted
___________________
NET ADJUSTED MERIT MARKS
______________________________________
Deficiencies in the application form if any
____________________________________
(i)
(ii)
(iii)
(iv)
(v)
SIGNATURE OF SIGNATURE OF
DEALING CLERK ADMINISTRATIVE OFFICER
REMARKS OF THE CHAIRMAN SELECTION COMMITTEE
_______________________________________________________
SIGNATURE OF THE CHAIRMAN SELECTION COMMITTEE
IMPORTANT DIRECTIONS FOR CANDIDATES
1. Every application for admission shall be accompanied by the Entrance Test
non-refundable fee of Rs.700/- in the form of pay-order or demand draft in the
name of Principal of the selection center and three copies of the following
documents to be attested only by a Government officer of Grade-18 or above,
along with original certificates.
a) Matriculation Certificate or equivalent issued by any board/authority of the
province.
b) Matriculation or equivalent marks sheet.
c) Original Intermediate Science or equivalent (pre-medical group) marks
sheet/equivalence of marks by any board or university.
d) Any other certificates such as Hafiz-e-Quran may be produced on an optional
basis.
e) Permanent Residence Certificate (Form “C”) of the candidate in accordance
with the existing Government rules.
f) Domicile Certificate of the father (on form P-I). In case the father is not alive
and no Domicile Certificate has been issued to him, the mother’s Domicile
Certificate shall be acceptable. The Domicile Certificate of the candidate shall
be accepted only if he/she is above 21 years of age, or his/her parents are not
alive (supported by death certificate) and no such Certificate was issued to
them or where the mother has remarried after death of the father.
g) Candidate producing equivalence certificates of examination other than
Intermediate Boards of Pakistan shall have to produce certificate from the
competent authority of having passed the following subjects:-
i. Physics, Chemistry, Biology and English .
ii. A pass certificate in Pakistan Studies, and Islamiat or Civics from any
Intermediate Board of Pakistan for muslims and non-muslims,
respectively.
iii. All the A-level and O level results submitted for the equivalence, calculation shall be
determined by the Inter Board Committee of Chairman, Islamabad. (IBCC).Address:
Secretary IBCC (Inter Board Committee of Chairman)Office No.342, Street No.97,
Sector-G9/4,Islamabad.
iv. Those candidates having studied courses equivalent to Intermediate
Science pre-medical from any institution other than a board or
university in Pakistan, will be eligible for admission, and if admitted will
have to pass Urdu/Sindhi, Islamiat/ Civics and Pakistan studies before
appearing in first Professional examination of M.B.B.S./B.D.S.
j) Five Affidavits/Undertakings may be given by the student on stamp paper of
Rs.20/- as per specimens given at appendix I, II, III, IV & V to the effect that
they are not admitted in any Engineering university and they have not
submitted any false documents.
k) The candidate’s National Identity Card, if the candidate has attained the age of
eighteen years or the relevant form if he/she is below the age of eighteen
years.
l) Six passport size photographs.
2. The application forms and required documents completed in all respect
shall be submitted to Principal / Head of the Medical Institution as given in
the Prospectus.
Candidates should please note that the Application form and the
attached documents shall not be returned in any case. The
certificates submitted in original can, however, be returned once
the admission process is over. However, original documents of the
candidates who are not selected only would be returned back on
demand to the Candidate himself / herself or candidate’s Father or
mother (on identification that he or she is the father or mother of
the candidate) along with a authority letter.
APPLICATION FORM FOR ADMISSION IN MBBS AGAINST
SELF FINANCE (LOCAL) CATAEGORY
ACADEMIC SESSION 2003-2004
NAME ____________________________________MALE/FEMALE
FATHER’S NAME_____________________________________________________
(GUARDIAN’S NAME, address & relationship with candidate)
__________________
PERMANENT ADDRESS_______________________________________________
_____________________________________________________________________
PRESENT POSTAL ADDRESS WITH PHONE
NO._________________________
_____________________________________________________________________
REQUIRING ADMISSION FOR WHICH
COURSE__________________________
(Write MBBS or BDS as the case may be)
PAY ORDER NO.________________DATED_____________FOR
RS._________
(RUPEES____________________________________________________________)
DATE OF BIRTH________________ DISTT. OF DOMICILE_________________
INTERMEDIATE SCIENCE (Pre-Medical) PASSED IN
YEAR_________________
(or Equivalent Examination) WITH DIVISION/GRADE_____-
__________________
TOTAL MARKS OBTAINED____________________________________________
HIFZ-E-QURAN CERTIFICATE_________________________________________
(Write “Nil” if not available)
DATE OF ISSUE____________NAME OF
INSTITUTION____________________
DATE _________ SIGNATURE OF
APPLICANT
APPLICATION FORM FOR ADMISSION IN MBBS AGAINST
SELF FINANCE (OVERSEAS)
CATAEGORY
ACADEMIC SESSION 2003-2004
NAME
_____________________________________MALE/FEMALE
FATHER’S
NAME______________________________________________________
(GUARDIAN’S NAME, address & relationship with candidate)
__________________
PERMANENT ADDRESS_______________________________________________
_____________________________________________________________________
PRESENT POSTAL ADDRESS WITH PHONE
NO._________________________
_____________________________________________________________________
REQUIRING ADMISSION FOR WHICH
COURSE__________________________
(Write MBBS or BDS as the case may be)
PAY ORDER NO._________________DATED_____________FOR
$._________
(DOLLAR____________________________________________________________)
DATE OF BIRTH_________________ DISTT. OF
DOMICILE_________________
INTERMEDIATE SCIENCE (Pre-Medical) PASSED IN
YEAR_________________
(or Equivalent Examination) WITH DIVISION/GRADE_____-
__________________
TOTAL MARKS OBTAINED____________________________________________
HIFZ-E-QURAN CERTIFICATE_________________________________________
(Write “Nil” if not available)
DATE OF ISSUE_____________NAME OF
INSTITUTION___________________
DATE _________ SIGNATURE OF
APPLICANT
IMPORTANT NOTE
Candidates are advised to complete all columns of the
Application read the prospectus for admission to the
Medical Institutions of Sindh for session carefully.
They are required to fill all columns carefully without
overwriting and make necessary attestation from concerned
institutions.
Incomplete forms will liable to be rejected.
Complete forms must reach within the stipulated time
period. No form will be accepted in any case after the last
date of submission of application form.
