Application FormRawalpindi Medical College, Rawalpindi
APPLICATION FOR ADMISSION TO
THE FIRST YEAR M.B.B.S. CLASS OF
THE MEDICAL COLLEGES
OF THE PUNJAB
2007-2008
Full name Mr./Miss. _________________________________________
Present Postal Address House No.____________________Street/Road____________________
Village/Mohallah_______________Police Station___________________
Tehsil/Town___________________District/City____________________
Country______________________
Tel: (R)____________ Tel: (O)_____________ Fax: _________________
Permanent Home Address
House No.____________________Street/Road____________________
Village/Mohallah_______________Police Station___________________
Tehsil/Town___________________District/City____________________
Country______________________
Tel: (R)____________ Tel: (O)_____________ Fax: _________________
Date of Birth / Age on last date of submission of application ________
Place of birth_______________Religion_________________________
Father’s name _____________________________________________
a). Occupation __________________________________________________________
b). Office Address __________________________________________________________
c). Tel: ( R ) ______________Tel (O) ____________Fax: ______________
Guardian's name (In case of death of both the parents) ___________________________________________________________
a). Exact relationship with the applicant: ___________________________________________________________
b). Occupation: ___________________________________________________________
c). Office Address ___________________________________________________________
d). Tel: ( R ) ______________Tel (O) ______________Fax:_____________
Father /Guardian Income i) Annual Income from all sources: ____________
ii). Amount of Income Tax / Abiana paid during previous year: ___________________
Home District (Present)________________Past if Any) ______________
Qualifications
Examination passed Board from which passed Roll No. and Regd. No. Date of passing Name of school or College Subjects Marks / Grades Obtained
1 Matriculation .. .. .. .. .. ..
2. Intermediate (Pre-Medical)/ Equivalent .. .. .. .. .. ..
.. .. .. .. .. ..
3. Entry Test .. .. .. .. .. ..
.. .. .. .. .. ..
Declaration of preferences for admission to the Medical Colleges.
Name of the Medical Colleges (in order of preference).
1. __________________________________________________________
2. __________________________________________________________
3. __________________________________________________________
4. __________________________________________________________
5. __________________________________________________________
6. __________________________________________________________
7. __________________________________________________________
Signature of the applicant __________________
Very Important: Preference once executed shall be final and can not be changed subsequently.
Solemn affirmation by the applicant
If a candidate is admitted on the basis of statements made in the above application and subsequently it is found that any of the statements was false, the candidate shall not be admitted and if admitted, he/she will be expelled from the college and all fees and other dues paid by him/her to the College upto that time shall be forfeited. The student and his/her father/guardian would also be liable to any further departmental or legal action that the Government may deem fit to take.
If it is discovered either before or after admission that a candidate has tried to secure or has secured admission to the college against a vacancy reserved for candidates from a particular Area/District of Punjab by securing a certificate from civil authorities to the effect that he/she is a bonafide permanent indigenous resident or is a person whose father having migrated from another district of Pakistan had settled permanently in that Area/District whereas in actual fact he/she and his/her father are not such permanent residents such candidate shall be refused admission to the college even if otherwise eligible or is admitted prior to the discovery of the true facts shall be expelled from the College at any time during the course of his/her training and all fees and the dues paid up to the time of such expulsion shall be forfeited and further shall be permanently debarred from admission to any Government Medical College or a Medical College aided by the Government of the Punjab and further the Government may if they deem fit debar such candidate/student permanently from admission into any Government or Government -Aided Teaching Institution other than a Medical College in Punjab and may also debar such person from any employment under Government or under any Autonomous Authority, or Semi-Autonomous Authority or any Local Body in Punjab.
Place_________________
Date _________________ Signature of the applicant _______________________
Solemn affirmation by father/guardian
I__________________________________________________________________
Father/guardian of Mr./Miss ____________________________________________________________________
an applicant for admission to a Medical College of Punjab, fully understand that if any of the statements made in the above application is found to be wrong in any way my son/ ward/ daughter would be liable to be refused admission to the college even otherwise eligible and if admitted would be liable to expulsion from the College 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/ ward and myself would be liable to any further departmental or legal action which government may deem fit to take.
I, also undertake to fulfil any other requirement in the shape of bond /affidavit required of me by the College/ Admission Board.
Place __________________________ Signature ___________________________
Date : ________________ Father/ Guardian
To be filled in by the candidates who are Hafiz-e-Quran. (attach certificate)
Mr/Miss __________________________son/daughter of _______________________
_____________________hereby solemnly declare that I am a Muslim Hafiz-e-Quran.
Signature of the applicant ________________________
To be filled in by the disabled students. (attach certificate)
Mr/Miss_________________________ son/daughter of _______________________
__________________________hereby solemnly declare that I am a disabled student.
Signature of the applicant _______________________
