kmu values - Khyber Medical University

N. I. C. _______________________________________________
Permanent Address: _____________________________________________
TO BE FILLED BY FATHER/GUARDIAN OF THE CANDIDATE
I _______________________________son/daughter/wife of ________ ________________________and Mother/Father/Guardian of
__________________________________________hereby fully endorse the undertaking given by my son/daughter/ward and assure that he/she will abide by this undertaking
during his/her stay in the Institute.
i) I also make myself liable to pay Rs. 1,00,000 (one Lac) per year of his/her study in the Institute in case of any breach of the above mentioned undertaking by my
son/daughter/ward Mr/Miss __________________________________ .
ii) I _______________________________ Father/Mother/Guardian of Mr./Miss _________________ ____________ __________ assure that my son/daughter/ward will
not indulge in politics of any type and will not be a member of any political party/ organization/students Federation nor will he/she attend any meeting of such result into
his/her expulsion from the Institute, and that the decision of the Principal in this regard will be find.
Witness-1 ____________________________
Signature) Deponent
Signature of the Father/Guardian of the student
Name________________________________ Full Name ________________________________
Father’s Name ________________________ Father’s Name ____________________________
Nat. Identity Card No. __________________ Nat. Identity Card No. ______________________
Temporary Address ____________________ Temporary Address ________________________
____________________________________ ____________________________________________
Permanent Address ____________________ Permanent Address ________________________
____________________________________ __________________________________________
Witness-2 ____________________________
(Signature)
Name________________________________ Nat. Identity Car No.________________________
IPM & R (KMU) Page 19