application form for admission in bs physiotherapy session 2011

Serial No. _________
APPLICATION FORM FOR ADMISSION IN BS PHYSIOTHERAPY
SESSION 2011
(The form should be filled in BLOCK letters)
Note: Please read the instructions given in the admission policy in the prospectus and on the reverse of
application form before filling this form
Please tick (√ ) in the relevant box from where you are applying for?
KP/ FATA: Balochistan: Foreign/Afghan:
Name:____________________________________________________ ________________________________________
(As per SSC or equivalent certificate in BLOCK letters)
Father’s /Husband’s Name:____________________________________________________________________________
(As per SSC or equivalent certificate in BLOCK letters)
Date of birth (yyyy/mm/dd):___________________________Gender: M / F Married/Unmarried
Place of birth:___________________________ Domicile:___________________ Nationality: ____________________
Mailing address:____________________________________________________________________________________
__________________________________________________________________________________________________
Phone: (Res)____________________ (Cell)__________________ Email:______________________________________
Permanent address:__________________________________________________________________________________
__________________________________________________________________________________________________
In case of emergency please contact
Name______________________________Address:________________________________________________________
__________________________________________________________________ Phone:__________________________
Have you entered in medical college entry test before? Yes / No If yes, record of entrance tests:
Educational Record
Qualification
SSC (Science)/
equivalent
F.Sc(premedical)
Year of
passing
For office Use only
Remarks / Requirements
Year Entrance test ID Results
Annual
/Suppl.
Exam.
Roll No
Marks
obtained
Total
mark
Receipt No. ___________________ Dated: ________ _________________
Attempts
Checked by Member of Scrutiny Committee: ______________________ Chairman Scrutiny Committee:
Paste three
photographs
Name of
board

Father's Income and Occupation:______________________________________________________________________
Guardian's Name: __________________________________________ Income & Occupation:________ _____________
Exact Relationship with the Guardian:_________ __________________________________________________________
Have you ever been involved in criminal proceeding in a Court of Law? If Yes, attach brief account:
_____________________
__________________________________________________________________________________________________
Name of School from where SSC passed: __________ _____________________________________________________
Name of college from where F.Sc Passed : ______________________________________________________________
Certified that facts produced are correct to the best of my knowledge.
Signature of the Applicant’s Father/Guardian Signature of the Applicant
NIC No:_________________________________. NIC No: _______________________________
Date: ____________________________________ Date: __________________________________
ATTESTED DOCUMENTS REQUIRED WITH APPLICATION FORM
The following documents must be attached with the application form in the following sequence:
Applicants must attach with application form the following attested Photostat copies of the below mentioned Certificates and documents in the
following sequence. The documents & certificates must be attested by Gazetted Officer/ Nazim. The stamp of the officer must bear full name,
designation and current place of duty
Note: Check (� ) the relevant box for the attached documents.
Two copies of detailed Marks Certificate of examination on the basis of which admission is sought (F.Sc or equivalent).
An equivalence certificate from the Inter-Board Committee of Chairmen, Islamabad, if the qualifying certificate is from an Institute abroad.
A copy of Secondary School Certificate Examination (Science /equivalent).
Two copies of domicile certificate (domicile certificate submitted with the entry test form will not be changed).
A copy of Computerised National Identity Card of the candidate, copied on Full size paper
A copy of computerized National Identity Card of the father of the applicant copied on Full size paper, if the father is not alive, a copy of the
National Identity Card of the mother & guardian.
A copy of attempt certificate from the concerned BISE, if the period between SSC and F.Sc is more than two sessions.
Undertaking on judicial stamp paper of Rs. 30/- duly attested by notary public /Political Agent as per specimen given in the prospectus/admission.
Three passport size coloured photographs of the applicant attested on the back.
IMPORTANT NOTES/INSTRUCTIONS
1. Photostate of Admission Form is not accepted.
2. Candidates not having domicile of KP/FATA are not eligible to apply for admission on KP/FATA seats.
3. All applicants must appropriately fill and sign the admission form and undertaking. Incomplete/not properly filled form in any respect
will be rejected. Avoid rewriting/cutting, while filling the form.
4. The undertaking/agreement must be filled in by the candidate on Judicial Bond of Rs. 30/- and should be duly attested by the Political
Agent/First Class Magistrate and attached with the application form. The specimen proforma for undertaking is attached with the
application form.
5. Applications should reach office of the Principal/Director on or before the closing date and time. Applications received after the due date
and time will not be entertained for admission. No forms will be accepted via mail/courier.
6. Applicant must study the Admission Policy of Khyber Medical University in order to understand the Rules.
7. The domicile, DMC of F.Sc. (Pre-Medical)/Equivalent Examination, SSC and other certificates once submitted with the admission form
cannot be changed and shall be considered as final. Revision of result or improvement of marks by the board/IBCC after the finalization of
merit list shall not affect the merit list of admission of current year in any way. All the above-mentioned certificates issued after the dates
fixed for receipt of application forms shall not be entertained.
8. Application forms with any false statement by the candidate will be rejected
9. If any certificate submitted by the candidate is found false, or forged during his/her study period his/her admission shall be cancelled
forthwith and he/she shall be blacklisted for admission to any professional colleges in KP. Further legal action can be taken against the
student under the existing criminal laws.