SHAHEED ZULFIQAR ALI BHUTTO MEDICAL UNIVERSITY

PIMS, G-8/3, Islamabad

ADMISSION FORM FOR Please ax 4
UNDER GRADUATE PROGRAMS Photographs
a ested form
(SESSION ) backside. (4x)

DPharm DPT BS Speech Language Therapy/Pathology BSc Nursing Generic

BSc Nursing Post RN BS Medical Technology
Instruc ons
1. Use CAPITAL Le ers and write your details exactly they appear in your documents.
2. Incomplete Registra on form will not be accepted.
3. A ached A ested Photo Copies of original Document.
4. Cu ng/ over wri ng is not allowed.
5. Candidates found to have made false or incorrect Statements in
the form are liable to expulsion.
Proposed Programme of Study
Name of School/College

Name of Program

Applicants Personal Informa on

1.Full Name (First, Middle, Last)

2.Fathers Name (First, Middle, Last)

3. Mar al Status 4.CNIC No.

Single Married

5. Date of Birth(DD/MM/YYYY) 6. Gender Male Female

7. E-mail:

8 Mailing Address
ii. Permanent Address

9. Domicile

10. Mobile Number 11. Land line Number 12. Blood Group

13. Educa onal Informa on

Passing Obtained/ No. of Grade/ Division
Qualica on Subject Ins tute/ Board/
University Year Total Marks A empts with Percentage

Matric/ O-Levels

Intermediate/ A-Levels

Diploma in Nursing

Bachelors/ Other

NAT Result

14. Documents to be a ached:

I have a ached a ested copies of the following documents with this form ( ck appropriate box)
04 photographs size (3x3 cm) paste at given place and 01 photograph size (3x3 cm) (a ested
from back side) a ach with admission Form.
A ach the Matric/O Level, Intermediate/A Level cer cates.
Diploma in General nursing registered with Pakistan Nursing Council.
Diploma in Midwifery for Male nurses one year specialized course registered with Pakistan
Nursing Council.
NAT Result.

15. CERTIFICATE BY THE APPLICANT

I hereby solemnly declare that : (1) the informa on provided and statement made by me in
this form are true and correct to the best of my knowledge and belief and nothing material
has been concealed or withheld herein. (2) I shall be responsible if my applica on form is
rejected for any errors, wrong or incomplete entries made by me. (3) I understand that
applying for admissions without being eligible for it is a crime punishable under the act of
law, and in such case, the University has every right to cancel my admission.

Date: __________ Signature of the applicant_______________