HS Copy > tes 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: 0332-3073121Candidate'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: 0332-3073121University 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