PRACTICAL / PROFESSIONAL WORK EXPERIENCES Institution Position Held Duration From To address of Candidate of Father Present address Permanent ad

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1 Dow University of Health Sciences, Karachi APPLICATION FORM for ADMISSION IN M. Phil, PhD and M. Phil Leading to PhD SESSION 2011 AT INSTITUTE OF BASIC MEDICAL SCIENCES (IBMS) M.Phil PhD M.Phil Leading to PhD Date: Application. (AP.) Photograph te: Candidates are advised to complete all columns of the Application. Please read the instructions for admission to the IBMS, of Dow University of Health Sciences for session carefully. Fill the Form in BLOCK LETTERS with BLACK PEN. Name of Applicant S/o, D/o Date of Birth Place of Birth Age on closing date Education details: Female Male DETAILS Matric Inter Science Date of Passing MBBS / MSc POST GRADUATE Name and address of Institution Total Marks Obtained A) Anatomy Speciality (Tick One Only) B) Physiology C) Biochemistry D) Pharmacology E) Pathology a) Haematology b) Histopathology c) Microbiology d) Molecular Pathology e) Genetics f) Chemical Pathology g) Biotechnology

2 PRACTICAL / PROFESSIONAL WORK EXPERIENCES Institution Position Held Duration From To address of Candidate of Father Present address Permanent address Contact s. of Candidate of Father any other Relative Tel.. Cell. Signature of father/guardian Signature of the Applicant DATE OF SUBMISSION D M Y

3 CERTIFICATE FROM PRINCIPAL OF MEDICAL COLLEGE (LAST ATTENDED) This is to certify that Mr. / Miss Son / daughter of Mr. was a student of this college having been admitted into class from till Name of College Address of College 1) Name of Students and Father s Name 2) Present address 3) Permanent Address 4) Final year MBBS examination a. Date of Passing College Registration. b. Division / Grade Total Marks Obtained / Maximum Marks c.. of attempts in which passed d. Whether received any warning or punishment during the time when he/she was student of the college, if so give details It is further certified that during his/her period of stay in this college his/her work, conduct & character was Place Date SIGNATURE OF THE PRINCIPAL WITH SEAL

4 Particulars of Father/Mother/ Guardian 1. Name 2. Occupation 3. Designation 4. Place of work 5. Name of organization 6. Office Address 7. Present Residential Address 8. Permanent Address 9. address 10. Office Phone Mobile Phone 11. Res. Phone 12. Any Other Contact Number 13. Annual Income 14. Religion 15. Nationality 16. NADRA NIC. 17. Domicile District Date of Issuance NOTE: If father is working abroad. These particulars must be endorsed by Pakistan embassy / consulate of the respective country. Signature of father

5 Fill all boxes with your present address Present Address Present Address Phone (Res.): Phone (Off.): Mobile. : Phone (Res.): Phone (Off.): Mobile. : Present Address Present Address Phone (Res.): Phone (Off.): Mobile. : Phone (Res.): Phone (Off.): Mobile. :

6 Health Certificate te: (Section A, B, & C will be filled by the candidate) Section A Name S/o, D/o Age Days Months Years Height: Weight: Present Address: Section B 1. Do you smoke? Do you take any medicine regularly?... If yes, Specify 3. Any history of allergy Do you suffer from any of the following diseases?... i. Epilepsy... ii. High Blood Pressure... iii. Psychiatric illness... iv. Rheumatic Heart Disease... v. Hepatitis B/C... vi. Physical Disability... If yes, Specify Section C Details of previous Vaccination Detail of Booster Vaccination 1. Measles Mumps Rubella Tetanus Pertussis Whooping Cough Hepatitis B... Certification: I hereby certify that the above information given by me is correct. Signature Father / Mother Signature

7 IMPORTANT INSTRUCTIONS FOR CANDIDATES 1. Candidates are advised to read the prospectus carefully for admission to the full time Postgraduate Program at INSTITUTE OF BASIC MEDICAL SCIENCES (IBMS) of Dow University of Health Sciences for session 2011, before submitting the application form. 2. Fill all the columns of application form in BLOCK LETTERS with BLACK PEN. 3. Be sure to tick the appropriate Box in the application form.. 4. Photocopies of all required documents must be attested by Govt. officer, grade 18 and above. 5. Photocopy of the application form and incomplete form will be rejected. 6. form will be accepted in any case after the last date and time of the application form. 7. Each application for admission should be accompanied by n Refundable Entrance Test Fee of Rs. 1500/- (Rupees fifteen hundred only) in the form of pay-order in the favour of Dow University of Health Science, (DUHS). 8. Carefully check the Required Documents list mentioned in the prospectus before submitting the application form. 9. Specimen of undertaking will be given when the candidate is declared eligible for provisional admission. 10. The application form and required documents completed in all respect should be submitted to United Bank Limited, Baba-e-Urdu Road, Branch, Karachi. Also please submit application form at our website. 11. If any eligible candidate has not received the admit card 48 hrs prior to the entrance test, he/she should contact DUHS Admission Office. 12. In case, their is any change in the date of Entrance test due to some unavoidable situation, it will be notified on the website of DUHS DO NOT submit the original documents alongwith the application form. 14. All queries should be sent on address mentioned on the Back page. 15. candidate should contact personally for any queries. 16. Daily visit the website of DUHS for announcement and informations.

8 Dow University of Health Sciences, Karachi. ADMIT CARD FOR ENTRY TEST OF ADMISSIONS IN M.Phil Leading to PhD Session 2011 at Institute of Basic Medical Sciences (IBMS) Candidate s Copy Roll. Father s Postal Address: Please Paste (1 x 1) Photograph Tel : Mobile : E.mail: Signature of Candidate Date: For Official Use Left Hand Thumb Impression of Candidate Time: Venue: te: See Instructions Overleaf Signature Seal Father s Postal Address: Dow University of Health Sciences, Karachi. ADMIT CARD FOR ENTRY TEST OF ADMISSIONS IN M.Phil Leading to PhD Session 2011 at Institute of Basic Medical Sciences (IBMS) DUHS Copy Roll. Please Paste (1 x 1) Photograph Tel : Mobile : E.mail: Date: For Official Use Signature of Candidate Left Hand Thumb Impression of Candidate Time: Venue: Signature Seal

9 INSTRUCTION FOR THE CANDIDATE 1. If there is any change regarding Entry Test, venue or timings, it will be mentioned on DUHS website. 2. Carefully read instructions for attempting test paper, otherwise computer will not read your answers. 3. Candidate must bring this Admit Card for the test, on the date, time and venue given overleaf. 4. CANDIDATE WILL NOT BE ALLOWED TO APPEAR IN THE TEST WITHOUT THIS ADMIT CARD. 5. Identification other than this Admit Card will be acceptable. 6. Impersonation for the Entrance test will be considered as a criminal case and will be dealt seriously. 7. Candidate is required to reach the venue at least two (02) hours before the test. 8. Any material or electronic device / mobile phone / calculator etc, will not be allowed, under any circumstances. 9. If any student is found, using unfair means or cheating he will be debarred from the test and admission.

10 DOCUMENTS REQUIRED: 1. MBBS Degree Valid PMDC Certificate House Job Certificate MSc Degree (if any) Postgraduate Degree (if any) Other Experience Certificate Pay order of entrance test Candidates CNIC NADRA 9. Candidates domicile of 10. Candidates PRC of 11. Father s domicile of 12. Father s CNIC NADRA. with permanent Address