1. Name of the Applicant (As per SSC or Equivalent Certificate in Block Letters) 5. Date of Birth 6. District of Domicile

Transcription

1 Open Merit Entrance Test ID. READ THIS FIRST APPLICATION FORM FOR ADMISSION TO First Year MBBS/BDS OF PRIVATE MEDICAL & DENTAL COLLEGES/INSTITUTIONS OF THE KHYBER PAKHTUNKHWA SESSION (THIS FORM SHOULD BE FILLED IN BLOCK LETTERS) 1. Please read Admission Policy and the Instructions before filling this Form. 2. Fill all fields in Blue/Black ink only. Tick ( ) the relevant boxes. 3. Cutting/erasing is not allowed. Forms with cutting/erasing are liable to be rejected. Paste Recent Color Photograph (3.5cm wide & 4.5cm high) attested on the front and attach three attested on the back Part 1 - Personal Information 1. Name of the Applicant (As per SSC or Equivalent Certificate in Block Letters) 2. Father s Name 3. Gender 4. Nationality M F 5. Date of Birth 6. District of Domicile D D M M Y Y Y Y 7. Computerized National Identity Card/ Form B No./passport No. 8. Mailing Address (Res.) in Pakistan only 9. Tel (Landline) 9.Cell 10 Alternate Cell 10. Address: 11. Have you ever been admitted/studying in any Medical/Dental College in Pakistan. If yes, mention name of the College. Page 1 of 6

2 Part 2 Declaration of Preferences VERY IMPORTANT: 1. A candidate will give his/her preference in order of priority for the Medical / dental Colleges in the designated spaces provided in the admission form which once given shall be final and cannot be changed subsequently. This condition is mandatory and neither any subsequent changes shall not be entertained nor any exceptions made. The candidate shall be considered only for those colleges for which he/she has shown his/her preferences. A candidate, under no circumstances will be considered for a college not listed in his/her preferences. The University shall not assign a college by itself if the alternate choices are not indicated. 2. Women Medical College Abbottabad, Women Medical College Dental Section Abbottabad and Peshawar College of Dentistry Peshawar is for female students only. Male students cannot opt for these colleges. Sr. No Full Name of the Institution Choice No. Signatures of the Applicant 1. Al-Razi Medical College, Peshawar 2. Jinnah Medical College Peshawar 3. Kabir Medical College, Peshawar 4. North West School of Medicine, Peshawar 5. Pak International Medical College, Peshawar 6. Peshawar Medical College, Peshawar 7. Rehman Medical College, Peshawar 8. Women Medical College Abbottabad For female students only 9. Abbottabad International Medical College-Dental Section, Abbottabad 10. Rehman College of Dentistry, Peshawar 11. Peshawar College of Dentistry, Peshawar For female students only 12. Sardar Begum Dental College, Peshawar 13. Women Medical College Abbottabad-Dental Section For female students only Page 2 of 6

3 Part 3 Qualifications Qualification S.S.C (Science or equivalent) F.Sc (Pre-Medical) or Equivalent Year of Passing Annual / Supplementary Exam. Roll No Marks Obtained Total Marks Attempt (s) Board / University Part 4 Admission Test (A) MEDICAL ENTRANCE TEST Medical Entrance Test ID/Roll No. Marks Obtained/Total Marks Percentage Please mention Provincial Admission Test Authority i.e. ETEA, MDCAT etc. (B) SAT II (only for candidates applying against Foreign Seats should not be less than 550//800). SAT II (Subject) Scores Chemistry: /800 Biology E/M : /800 Physics or Maths I/II: /800 Total: /2400 Test Date(s) Username & Password (C) MCAT conducted by AAMC (only for candidates applying against reserved seats for Children of Overseas Pakistani/Dual Nationality Holder s should not be less than 498/528. MCAT Score Test Date Username & Password / 528 (D) Foreign MCAT with minimum score of 500. Foreign MCAT Score Test Date Username & Password / 528 Part 5 Hafiz-e-Quran Are you Hafiz-e-Quran Yes No Page 3 of 6

4 Part 6 Miscellaneous i. Father s Income and Occupation ii. iii. iv. Guardian s Name Income &Occupation Exact Relationship with Guardian Income tax or land revenue paid by your parents/guardian a. Income tax b. Land revenue v. Were you ever involved in criminal proceeding in a court of LAW? If Yes, attach brief account vi. Name of School from where SSC/equivalent Passed vii. Name of College from where F.Sc. Passed Part 7 Bank Transaction Details Application Processing Fee: Rs. Bank Deposit Slip No: MCB Branch/Code: Dated: Part 8 Adjustment of Marks Hafiz-e-Quran Marks Deduction SSC 10% Weightage F.Sc 40% Weightage Entry Test 50% Weightage Merit Score Part 9 Remarks/Deficiencies Part 10 Fee Structure for Open Merit S.No Fee and Charges Amount 1 Annual Tuition fee per student excluding, university Not exceeding Rs: 950,000/- examination fee, taxes, hostel fee and transport fee, etc. 2 One time admission fee Not exceeding Rs. 50,000/- 3 Prospectus fee Not Exceeding Rs. 3,000/- Note: The selected candidates for admission must deposit prescribed admission fee within 7 days of display of final merit list on website or notice board of the admitting university. In case of failure to deposit the prescribed fee, such candidates shall have no vested right of admission in that year. Page 4 of 6

5 Documents Required The following documents must be attached with the application form 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. 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 Hafiz-e-Quran certificate if the candidate claims to be Hafiz-e-Quran. Three (03) copies each of computer generated result cards of Entrance Test/SAT II/MCAT scores. A copy of Secondary School Certificate Examination (Science /equivalent). A Copy of Computerized National Identity Card / Computerized Form-B of the candidate copied on full size paper. A copy of computerized National Identity Card of father of the applicant copied on full size paper. If father is not alive, then a copy of the National Identity Card of the mother and guardian. Migration certificate from the concerned board/university. A copy of attempt certification from concerned BISE, if the period between SSC and F.Sc is more than two sessions. Three passport size coloured photographs of the applicant with name, father name, and attestation on the back. A Copy of Wealth Statement, Income Tax return of Parent/Guardian of last financial year. Insurance Certificate to ensure the payment of fees for the remaining duration of the course in case of demise of parent/guardian at the time of admission. For office use only Received the Admission Form vide Receipt No. this day of, on Name & Signature of the Dealing Officer Page 5 of 6

6 Solemn Affirmation by the Applicant I S/D/O solemnly affirm that the information contained in this Admission Form, and the documents attached with this form, are complete and accurate. I understand that if any information in this application, or in the documents and certificates that are attached with this application, is not complete or accurate, I shall not be considered for admission. I have gone through the Admission Policy and PM&DC MBBS and BDS Admissions, House Job and Internship regulations, 2018, and I undertake to abide by all conditions. I understand that the choices for colleges given by me in this Admission Form are final and no subsequent change is permissible. I agree that submission of this Admission Form does not confer any right on me in respect of selection for admission, which shall only be granted on merit. Name of Applicant Signature of Applicant Date: Thumb Impression (Left Thumb for Male and Right for Female) Declaration of the Father/Mother/Guardian I, Father/Mother/Guardian of Mr./Ms. an applicant for admission to a private medical/dental college/institution of Khyber Pakhtunkhwa, fully understand that if any of the statements made in the above application is found to be wrong in any way my son/ daughter would be liable to be refused admission to the institution even otherwise eligible and if admitted would be liable to expulsion from the institution at any time during the course of his/her studies and in such a case, all fees and other dues paid by him/her up to the time of expulsion shall be forfeited and that my son/ daughter would be liable to any further departmental or legal action which Government may deem fit to take. I, also undertake to fulfill any other requirement in the shape of bond/affidavit required of me by the government/institution. I also undertake and declare that I can afford to pay the annual fee for all sessions and that I shall pay it in the beginning of each academic session. Name of Father / Mother/Guardian Father / Mother/Guardian CNIC No: or Passport Number Signatures of Father / Mother/Guardian Page 6 of 6