Serial No: _____ Roll No:_____

UNIVERSITY OF HEALTH SCIENCES Lahore

Khayaban-e-Jamia Punjab, Lahore
Ph. No. (Off) 042-9230395 (6 lines), Fax: No.9230394

Admission Form for M. Phil 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,
Please Paste
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. photograph here

Please fill in the form with black ink only in CAPITAL letters and avoid contact with the edges of the attested from
boxes. A box may be left empty wherever a word ends and a new word begins in the same line or front side (3X3 cm)
where nothing further is to be written. with blue

Avoid any over-writing and other mistakes while filling in the form. Please make sure the form is filled
background
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 

Admission form for M. Phil: Primary Final

1
0
APPLICANT’S PERSONAL INFORMATION

Full Name (first, middle, last)

2
0

Father’s Name (first, middle, last)

3
0

Applicant’s NIC
4

Name of Institution
5
0

Registration Number
6 _ _ _
U H S
0

Passing M.Phil (Primary) Annual Supplementary Held in ----------- Year --------- Under Roll No. ------
7
0
8 Nationality: ………………………………………………………………………………………………..

Mailing Address (mention all relevant information like post code etc.)
9
…………………………………………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………..

Mobile/Telephone Number (with city code) E-mail / Fax #

10

Page 1
 Appearing as Fresh / Repeater (tick whichever is applicable)
11
If Repeater, Number of attempts already made (excluding this attempt): …………………………………………
Previous appearances:
First Attempt : Annual / Supplementary 200 …….. Roll No ……
Second Attempt : Annual / Supplementary 200 …….. Roll No ……
Third Attempt : Annual / Supplementary 200 …….. Roll No ……
Fourth Attempt : Annual / Supplementary 200 …….. Roll No ……

12 Subjects in which to be examined

Major: ----------------------------------------------------------------------------------------------------------------------------

Minor 1: ----------------------------------------------------------------------------------------------------------------------------

Minor 2: ----------------------------------------------------------------------------------------------------------------------------

13 Fee Paid Rs: Mode of Payment Draft Bank Receipt

Draft/Bank Receipt No: ______________________ Date: - -
(DD / MM / YYYY)

NOTE: Attach original Bank Draft/Bank Receipt with this form

Documents to be attached
14
I have attached attested copies of the following documents with this form (tick appropriate box)

Degree of MBBS DMC of M.Phil (Primary) for M.Phil (Final)

03 photographs size (3x3 cm) paste at given place and

01 photograph size (3x3 cm) (attested from back side) attach with admission form.

15 CERTIFICATE BY THE APPLICANT

I hereby solemnly declare that : (1) the information provided and statement made by me in this form are
true and correct to the best of my knowledge and belief and nothing material has been concealed or withheld
herein. (2) I shall be responsible if my application form is rejected for any errors, wrong or incomplete entries
made by me. (3) I understand that applying for examination without being eligible for it is a crime punishable
under the act of law, and in such case, the university has every right to cancel my result.

Date: _____________________ _________________________

Signature of the applicant

CERTIFICATE BY THE DEAN

16
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/Dean
(with official stamp/Seal)

Page 2
 UNIVERSITY OF HEALTH SCIENCES Roll No : _______
Lahore (Office use only)

Roll NO SLIP
(FOR SUPERINTENDENT)

Examination: _____________________________________________
Name: _____________________________________________
Please Paste
Father’s Name: __________________________________ photograph here
Name of Institution: ________________________________ attested from front
side (3X3 cm)
Subjects in which to be examined: ____________________________ 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
examination centers.

_________________________
Signature of the Candidate

……………………………………………………………………………………………………………………………………………………

UNIVERSITY OF HEALTH SCIENCES Roll No : _______

Lahore (Office use only)

ROLL NO SLIP
(FOR CANDIDATE TO BE HANDED OVER TO THE SUPERINTENDENT)

Examination: _____________________________________________
Name: _____________________________________________
Father’s Name: _________________________________ Please Paste
photograph here
Name of Institution: ________________________________
attested from front
Subjects in which to be examined: ____________________________ 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
examination centers.

_________________________
Signature of the Candidate

Page 3