SINDH INSTITUTE OF MEDICAL SCIENCES (SIMS)

Karachi-74200 Passport size

Ph 99215718, 99215752, Fax: 021-99215469 Photo
Email: info@siut.org Website: http://www.siut.org (Paste)

ADMISSION FORM

Department/Program: ____________________________________________________________________________________
(Please mention serially your choice of [all] Technology Courses as given in Admission Advertisement)

______________________________________________________________________________Class applied for: ___________

Name (in block letters): _____________________________________________________________________ Sex: _____________

Date of Birth: DD __ __/MM __ __/YR __ __ __ __ Nationality: _______________________________________________

Fathers Name: ____________________________________ Fathers Occupation: ___________________________________

Applicants CNIC - -

Domicile and PRC: _______________________________________________________________________________________

Mailing Address: ________________________________________________________________________________________

________________________________________________________________________________________________________

Telephones Home: ____________ Off: ____________ Cell: ________________ Email: _______________________________

Permanent Address: _____________________________________________________________________________________

_______________________________________________________________________________________________________

Next of Kin (Name): ________________________________________________ Relation: _____________________________

Telephones Home: ____________ Off: ____________ Cell: ________________ Email: ______________________________

Passport number (for foreigners): __________________ Date of issue: ______________ Country: _____________________

Qualifications (Tick and complete all applicable)

Certificate or degree Board or University Year of passing Division Major subjects Optional subjects

Matric/SSC/ O & A levels

Inter Arts/Science/Others

BA/BSc/BS/Others

MA/MSc/M Phil/Others

MBBS/MD

FCPS or equivalent

Other Degrees

All documents are subject to verification

All information (including spelling of my NAME and my FATHERS NAME as it appears in the school leaving
certificate) is correct. Should any of the statements made in this application be found incorrect, the Institute may take
such action against me as it may deem fit, including cancellation of my admission and enrolment.

Dated: ________________ Candidates signature: _______________________

 INSTRUCTIONS

1. Type or write clearly using blue or black ink

2. Incomplete forms will not be accepted
3. Original documents must be brought for verification at submission of application
4. In case the Educational Facility last attended was other than Karachi University, a Migration Certificate from
the Facility concerned will be required in due course.
5. Attested Documents to be submitted with this application form:
2 recent passport size color photographs
Photocopies of:
i. Computerized National Identity Card (CNIC)/Passport incase of Foreigners
ii. Valid PMDC/PNC Registration certificate as relevant
iii. All relevant educational degrees etc including Matric or equivalent
iv. Any other necessary documents asked for

REGULATIONS

1. No student will be eligible to attend classes or appear in any examination without Enrolment
2. The Enrolment number should be quoted in any correspondence or future applications
3. Students are expected to maintain the highest standards of professional conduct, respect the rights of teachers,
colleagues, patients, and all health professionals. They are expected to demonstrate appropriate professional
conduct at all times during their course of studies at the SIMS. Inappropriate conduct may result in disciplinary
action including expulsion

FOR OFFICIAL USE

Remarks and orders by concerned official: