No.

______________

GOMAL UNIVERSITY DERA ISMAIL KHAN

N.W.F.P, PAKISTAN
ADMISSION 2009

PHOTOGRAPH

Application for admission to_____________________________________________________

(Name of Academic Program)

Number of Category/Quota/Seat against which seeking admission____________________

i.
ii.
iii.
iv.

Application should be filled in by the applicant correctly and legibly.

Separate application form be filled for admission to each program.
Give names of other academic programs applied for admission____________________
Incomplete application will be rejected.

1.
NAME (in capital letters)_________________________________________________________
2.
FATHER'S NAME _____________________________________________________________
3.
FATHER/GUARDIAN'S OCCUPATION ____________________________________________
4.
PLACE OF BIRTH ___________________________5. DOMICILE. ______________________
6.
DATE OF BIRTH_____________________________ 7. N.I.C.
NO._______________________

(As in Matric Certificate)

8.
DO YOU WISH TO LIVE IN HOSTEL (circle one)_____________________________ YES / NO
9.
ACADEMIC RECORD (from Matric onward).
School/College/ Exam:
Marks Obt/
Grade/
DistinYear
Roll No
Subjects
University
passed
Total Marks
Division
ction
1
2
3
4
5

10.
11.

University / Board Registration No. of Previous Class._________________________

Have you ever been admitted to any post-Graduate Degree / Diploma in this or any
other university? If yes please mention.
Name
of
the
Program_____________________________
session
______________
Registration No. _____________________________________________________
Institution _____________________________________________________________

12.

Extra-Curricular Activities such as Sports / Societies / Union etc.

_____________________________________________________________________

_
13.

For B.Ed /M.Ed candidates only.

Are you in service
Yes / No
Designation _________________ Length of Service/Experience _______________
Name of School / Institution ____________________________________________

14.

MAILING ADDRESS (Preferably in Urdu)

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

15.

PERMANENT ADDRESS (Phone / Mobile No. if any)

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
16.

ADDRESS AND PHONE / MOBILE NUMBER if any of the person nearest at hand
who may be informed in case of emergency.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

17.

DECLARATION BY THE APPLICANT

I hereby certify that the entries made in the application are correct to the best of my
knowledge and belief, and that I have read the prospectus / conditions of admission
thoroughly and promise to abide by the rules / regulations of the University and the
orders of the University authorities in force at present or to be framed thereafter.
I also declare that:
a). I have not joined any other College/Department in this University or else where
at present.
2

b).

I shall be responsible for the consequences if any information given by me in

this application form is proved false at any stage and note that in addition to
any other action my admission will be liable to cancellation, abinito.

Dated ______________
18.

19.

a).
b).
c).

d).
e).
f).

(Signature of Applicant)_________________

DECLARATION BY PARENTS / GUARDIANS

a)
I certify that my son / daughter / ward makes this application with my
knowledge and consent and that I hold myself responsible for his / her conduct
and financial liabilities. My monthly income from all sources is
Rs.______________.
b).
I hereby agree that in the event of any injury, damage or loss resulting from any
cause whatsoever to my son / daughter /ward in the course of training / studies
in the Gomal University, I / my / he / his / her heirs shall have no claim whether
for compensation or otherwise against the institution / university / Government.
Dated ______________(Signature of Parent/Guardian)___________________
FOR FOREIGN STUDENTS ONLY

In addition to above, the foreign students are also required to give the following
information:
Sponsoring Agency / Country ______________________________________________
Passport No. _________________________ Valid upto ______________________
Type of Visa you now hold (Circle one)
i. Student.
ii. Exchange Visitor.
iii. Government Official
Visa valid upto ______________________________________________________
Whether registered in Local Police Station______________ Yes / No___________
Score of TOFEL / ILETS _______________________________________________

Selected / Rejected
Member (s) Admission Committee
DEAN OF FACULTY

Chairman/Director/Principal
of program concerned
20.

FOR OFFICE USE ONLY

i.
Date of receipt of application.______________________________________
ii.
Dairy number. __________________________________________________
3

iii.
iv.
v.

Position in order of merit. _________________________________________

Adjusted marks (if applicable).________________________________________
Status of admission. _____________________________________________

INSTRUCTIONS FOR APPLICANTS / CANDIDATES

Applicant must attach with the application form the following attested documents.
1.
2.
3.
4.
5.
6.
7.
8.
9.

Three passport size photographs (optional for female candidates).

Photocopies of Secondary School Certificate, FA/F.Sc, BA/B.SC or Diploma, whichever is
applicable.
Detailed Marks Certificates of all parts of Examinations.
Character Certificate from the Head of the Institution most recently attended by the
applicant
N.C.C /W.G Certificate (only for Pharm-D/BBA/B.Com/JDPE. Etc).
Domicile Certificate.
National Identity Card.
Migration Certificate (if not already registered in Gomal University).
Letter of nomination, departmental permission and study leave (if required).

As ordered by the Supreme Court on 1 st July, 1992, all the candidates and their parents /
guardians must submit " UNDERTAKING", on the stamp paper worth Rs. 30/- (the specimen of
which is given in the Prospectus) at the time of admission.
It is compulsory for the parents / guardians to accompany their sons/ daughters in person at the
time of admission and furnish a Surety Bond in the sum of Rs. 1,00,000/- duly attested by a
Magistrate that if their sons / daughters indulged in any disruptive activity or were found in
possession of firearms, not only would they be rusticated for three years but also they would forfeit
the bonded money.
Note; Candidate must get the receipt at the time of submission of the application.

Detail of the Category/Quota/Seat against which seeking admission

Category Name
Open Merit
D.I.Khan Division
Bannu Division
TA/FR D.I.Khan & Bannu
TA(FATA,PATA) Other TA/FR D.I.Khan &Bannu

S/D of GU Teacher
S/D of GU Employee
S/D of Army Personal
S/D of Professional
Serving Army Officer

Number
01
02
03
04
05
06
07
08
09
10

Category Name
All Pakistan Basis
Punjab
Sindh
Baluchistan
N.W.F.P
Azad Jamu & Kashmir
Occup: Kashmir Refugees
Sports
NWFP Female Quota
Selfsustaining Programe

Number
13
14
15
16
17
18
19
20
21
22
4

Bhakkar District
Northern Areas

11
12

Foreign Students
(on Self-Finance Basis)

23