Khyber Medical University, Peshawar

Institute of Basic Medical Sciences

Admission Form
MPhil leading to PhD & PhD Programme

Serial No:__________

Spring/Fall semester (Session 2011-2012) Discipline (Applied for) __________________________________

Note:

I. Please read the instructions given in the admission policy in the prospectus
II. Fill the form in BLOCK letter

Personal Details
Name: Mr/Miss/Mrs________________________________________

Gender: Male

Female

Fathers /Husband Name:_________________________________

Religion:_____________________

Date of Birth:_______________________

Nationality:____________________

Domicile:________________

CNIC No.

Contact No._______________

Mobile No.____________________

Designation with Department

(in case of employee)

E-mail Address:__________________________________________________

Address:

_______________________________________

H.No.__________Street No./Muhallah________________

_______________________________________

P/O__________________________Village/City_________________
District________________

Tehsil__________________

Province________________________________________

Academic Record
Examination

Roll No

Year of Passing

Board / University

Marks obtained

Total Marks

Division / Grade

SSC
FSc
MBBS/BDS
M Phil/ FCPS

GAT General/Subject Test Result

GAT General Score___________ Passing Date________________________ Valid up to dated_________________
GAT Subject Score ___________ Passing Date________________________ Valid up to dated_________________
HEC Indigenous Scholar

Yes

PIN # _________________________________________

NO

Research Experience and publications:_________________________________________________________________

(Attach list of publication and experiences certificates if any)

I certify that the particulars given above are correct. I pledge to abide by the Rules and Regulations of the University.

Date:__________________
For Office Use Only
Member Name

Signature:______________________
Admission granted
Designation

Block IV, PDA Building, Phase-V, Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
Tel: (092-91-9217703, Fax: 092-91-9217704

Yes

NO
Signature

www.kmu.edu.pk