HIGHER EDUCATION COMMISSION Attach Photograph

here
H-9, ISLAMABAD (PAKISTAN)
(Put Name and
PROVISION OF HIGHER EDUCATION OPPORTUNITIES FOR Attestation at the
back)
STUDENTS OF BALOCHISTAN AND FATA PHASE-II
http://www.hec.gov.pk

APPLICATION FORM FOR UNDERGRADUATE PROGRAMS

All Bachelors Programs Offered By Universities/Institutes/DAIs
e.g: B.E/B.Sc (Engineering), MBBS, BDS, BBA, B.Com (Hons.), B.Pharmacy, BCS, BSc (Hons.) etc.
Instructions to fill the form:

1. Fill the Application Form using Microsoft word.

2. Attach attested photocopies of all educational testimonials with the form.
3. An amount of Rs.200/- as application processing fee (non refundable) may be deposited in the HEC Online A/C
No. 17427900133401 in Habib Bank Limited, Shalimar Recording Company Branch, H-9, Islamabad.

Eligibility Criteria

a Is your age less than or equal to 22 Years on 18, August 2017 Yes No

b Have you obtained 60% Marks in FA/F.Sc or Equivalent Yes No

If No in case of (a) or (b) then you are not eligible.

Personal Details

Applicant Full Name: AFAQ AHMAD KHAN

(As given in Matriculation / S.S.Certificate)
Fathers Name: DILAWAR KHAN

Guardian Name: N/A

(In case of deceased father)
Relationship with Guardian: N/A
Applicants CNIC: 12101-9457553-5 (Attach Attested Photocopy of CNIC or B form)

Fathers / Guardians CNIC No: 11101-5249410-9 (Attach Attested Photocopy)

Applicant Domicile: South Waziristan Agency

(District / Agency / Frontier Region (FR))
Fathers Domicile: South Waziristan Agency
(District / Agency / FR)

Date of Birth: 20 April 1998 Gender: Male Female

(e.g: 01 Nov 1998)
Day Month Year

Age as on (18.08.2017) 19 03 11
(e.g:21 Years 02 Months 11 Days) Years Months Days

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i) Postal Address (Where you want to receive letters from HEC):

House No. 2017/E Gali Bagh Wali Opp: Laghari Gate City

Dera Ismail Khan

District/Agency/FR________ Dera Ismail Khan ________ Province _____Khyber Pakhtunkhwa__ _____

(Please note: Postal address should be of major city to receive letters from HEC)

ii) Permanent Address (if different from the above postal address):

Village Dabkot South Waziristan Agency

City South Waziristan Agency

District/Agency/FR_______ South Waziristan Agency Province: ____________ South Waziristan Agency

Phone No:

i) Residence (with city code): __________Nill___________

ii) Mobile Number: (Compulsory) __________0336-2590007 ___________

iii) Fathers/ Guardian Office Number (with city code): __Nill_ Mobile No: ___ 0342-9831001 __ ____

iv) Any other contact Number (with city code): __________Nil ___________

E-mail Address: (Compulsory) __________bk.1995wazir@gmail.com ___________

(Note: If you dont have any email account create it as most of the future correspondence will be done by E-mail.
Do not change your E-mail address
Check your e-mails frequently.)

Domicile: Candidates Domicile (Tick ( one of the following and attach attested photocopy)
i. FATA:
Name of Agency/FR: __________ South Waziristan Agency ___________

1 Bajaur 2 Khyber 3 Kurram 4 Mohmand 5 Orakzai

North South 8 FR FR Kohat FR
6 7 9 10
Waziristan Waziristan Peshawar Bannu
11 FR Lakki 12 FR D.I. Khan 13 FR Tank
ii. Balochistan:
Name of District: ___________________________

1 Kalat 2 Mastung 3 Khuzdar 4 Awaran 5 Washuk

6 Kharan 7 Lasbela 8 Ketch 9 Gawadar 10 Panjgur
11 Naseerabad 12 Jaffarabad 13 Jhal Magsi 14 Bolan 15 Quetta
16 Pishin 17 Loralai 18 Chagi/Dalbadin 19 Nushki 20 Sibi
21 Harnai 22 Ziarat 23 Kohlu 24 Sherani 25 Zhob
26 Dera Bugti 27 Killa 28 Musa Khail 29 Barkhan 30 Killa
Abdullah Saifullah
Fathers Domicile: (Tick (one of the following and attach attested photocopy)

i) FATA Name of Agency/FR ________ South Waziristan Agency ________

ii) Balochistan Name of District ___________________________
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To Be Filled by Already Enrolled Students
Name of Institution /University N/A
Registration No: N/A Program Name N/A
Duration of Program N/A Date of Enrollment N/A
Total Semester/Years Attended N/A Current Semester/Year of Study N/A
Discipline N/A
(Note: Please attach copy of admission Letter of your Institution or latest fee receipt (challan form) paid showing that you are a
full time student)

Educational Details
* If Information regarding Educaitonal Field found incorrect, the application would not be proceeesed.

Marks obtained
Name of Certificate (as mentioned in Name of Institution /
Educational (Give exact title, as Year of Total
your final year School / College
Level written in the Passing Marks Sheet ) Marks
testimonial)

SSC / Matric Working Folks

Detail Marks 826
OR 2015 1100 Grammar School Dera
Certificate
*O-level Town Di Khan

FA/FSc Detail Marks Part 1st: Punjab Group of

OR Certificate 2017 392 550 College Meraj Campus
*A-level (Part I) DI Khan

* O-level and A- level applicants will have to provide equivalence of grades/percentages and attestation from IBCC
(Inter Board Committee of Chairman) without which applications will not be processed.

Note:Does your intermediate level Institute / College lies in territory defined for Balochistan & FATA (

if Yes tick
IN
If NO tick OUT
Bank Slip Details
Original Bank Slip worth Rs. 200/- No: __1865812___Date : __ 31 July 2017 _ __

Drawn on Bank: __ HBL _ __ Branch: __ Circular Road D.I.Khan (1359)___

Applicant Persnol Bank Account No: __ Nill __ _

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Choice of Test Centre
Select centre where you will appear for Apptitute test (Tick (one of the following):

Islamabad Peshawar Quetta Karachi Lahore

(Note: Request for change of center will not be entertained once choice is exercised. In case candidate does not tick the
choice of center for test he/she will be placed according to his /her domicile.)

Check the list of attested documents to be attached with the application form:
One passport size recent photographs (Attested at the back)
Rs. 200/- origional bank receipt. (Photocopy of the bank receipt or any other form of payment is not
acceptable).
Applicants CNIC
Applicants Domicile/Local Certificate
Fathers or Guardians CNIC
Father or Guardians Domicile/Local Certificate

Undertaking by Applicant:
I solemnly verify that the particulars stated above are correct to the best of my knowledge and belief. In case
any discrepancy is identified by HEC at any stage, the scholarship shall be immediately terminated and I will
have no right of appeal or seek relief from court of law. Consequently I'll be liable to pay back the entire amount,
released by HEC under various expenditure heads, against the scholarship.

Signature: ___________________________________

Date: _____31/07/2017_______

The Application forms completed in all respect along with all the required documents should be reach by the
registered post or courier service by 18th August 2017 at address.

Bahram Jan
Sr. Project Manager
Provision of Higher Education Opportunities for Students of Balochistan and FATA (Phase-II)
Higher Education Commission
H-9, Islamabad

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