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Medical Entrance Test 2016 SZ
University of Health Sciences Specialized Healthcare &
Lahore Medical Education Department
APPLICATION FORM
Note: Fil all fields in capital lewers and tick (¥) the relevant box with blue ball point.
A. PERSONAL
Paste Recent Color
Photograph
(8.5.em wide x 45 em high)
Name of Applicant:
Father's Name:
Gender; Male Female Nationality:
Domicile: Punjab [__]
Gilgit-Battistan [| Islamabad (IT) [__]
District of Domicil
Date of Birth: ]
CNIC / B-Form No,
Mailing Address:
Contact: Mobile:
E-mail:
B. QUALIFICATIONS
Group/Major
Subjects
Marks/Total
Exam Roll No, Mais
Board/University
SSC / Equivalent
HSSC Part-I
HSSC Part-II /1100
C. UNDERTAKING
Thereby declare that all the information provided in this Application Form is complete and
correct. I understand that withholding any information solicited in this application or giving false
information shall make me ineligible for Entrance Test. I also understand that mere appearance in the
Entrance Test does not, in any way, make me eligible for admission which will only be granted after
fulfillment of criteria as prescribed in the Information Booklet. I solemnly declare that even after the
Entrance Test, if found ineligible for the said test, my test result will stand null and void ab initio
Signature of the Applicant
Name:,
Date:
Note: Please bring this form along with the emailed roll no, slip on the day of examination to the test center for verification.
Entrance will not be granted without this form and the roll no. sip.
Banklslami Helpline Numbers: 042-35760203, 042-35776793 & (42-35760I41 Ext: 2552, Cell No: 0332-3073121Candidate's Copy
University of Health Sciences
Lahore
Medical Entrance Test 2016 SEZ
Ithcare &
Medical Education Department
APPLICATION FORM
Note: Fill all fields in capital letters and tick () the relevant box with blue ball point.
A. PERSONAL
‘Name of Applicant:
Father’s Name:
Gender: Male Female Nationality:
Paste Recent Color
Photograph
(8.5 om wide x 45 cm high)
Domicile: Punjab |__| Gilgit-Baltistan Islamabad (ICT)
District of Domicile:
Date of Birth: ] CNIC/B-Form No.:
PS Te Ve ea
Mailing Address:
Contact: Mobile:
E-mail:
B. QUALIFICATIONS
Marks/Total
Exam Roll No. ee Board/University on
SSC / Equivalent
HSSC Parl |
HSSC Part-ll /1100
C. UNDERTAKING
T hereby declare that all the information provided in this Application Form is complete and
correct. I understand that withholding any information solicited in this application or giving false
information shall make me ineligible for Entrance Test. I also understand that mere appearance in the
Entrance Test does not, in any way, make me eligible for admission which will only be granted after
fulfillment of criteria as prescribed in the Information Booklet. I solemnly declare that even after the
Entrance Test, if found ineligible for the said test, my test result will stand null and void ab initio,
ignature of the Applicant
Name:
Date:
Note: Please bring this form along with the emailed roll no. slip on the day of examination to the test center for verification.
Entrance will not be granted without this form and the roll no. slip.
Banklslami Helpline Numbers: 042-35760203, 042-35776793 & 042-35760141 Ext: 2552, Cell No: 0332-3073121University of Health Sciences
Lahore
Bank's Copy
Medical Entrance Test 2016
Specialized Healthcare &
Medical Education Department
APPLICATION FORM
Note: Fill all fields in capital letters and tick (¥) the relevant box with blue ball point.
A. PERSONAL.
Name of Applicant:
Father’s Name:
Gender: Male Female
Nationality:
Domicile:
Punjab
(-Baltistan
Gilgi Islamabad (ICT) [
District of Domicile:
Date of Birth:
DD
Mailing Address:
Paste Recent Color
Photograph
(8.5 om wide x 4.5 em high)
CNIC / B-Form No:
Contact:
E-mail:
B.
Exam
QUALIFICATIONS
——
Pere ‘Group/Major
: 5
Subjects. | Board/University
Marks/Total
Marks:
SSC / Equivalent
HSSC Part-I
HSSC Part-II
/1100
Cols
UNDERTAKING
T hereby declare that all the information provided in this Application Form is complete and
correct. I understand that withholding any information solicited in this application or giving false
information shall make me ineligible for Entrance Test. | also understand that mere appearance in the
Entrance Test does not, in any way, make me eligible for admission which will only be granted after
fulfillment of criteria as prescribed in the Information Booklet. I solemnly declare that even after the
Entrance Test, if found ineligible for the said test, my test result will stand null and void ab initio.
‘Signature of the Applicant
Name’
Date:
Note: Please bring this form along with the emailed roll no. slip on the day of examination to the test center for verification.
Entrance will not be granted without this form and the roll no. slip.
Banklslami Helpline Numbers: 042-35760203, 042-35776793 & 042-35760141 Ext: 2552, Cell No: 0332-3073121