KHYBER MEDICAL UNIVERSITY

APPLICATION FORM FOR ADMISSION TO

1st YEAR BDS
KMU INSTITUTE OF DENTAL SCIENCES, KOHAT
SESSION 2017-18
Serial No: ___________
Photo
(This form should be filled in BLOCK letters)
Note: Please read the instructions given in the admission policy and the prospectus before filling this form.

CATEGORY OF SEAT APPLYING FOR:

Subsidized Open Merit (Khyber Pakhtunkhwa, FATA, PATA)

Subsidized (FATA in only) Semi Subsidized

Note: Candidate applying for any of above catagories must tick the box. Unticked box will be considered crossed.
The candidate can tick more than one box if he/she desires.

1. Name: ___________________________________________________________________________________________
(As per SSC (Science) or equivalent certificate in block letters)
2. Date of Birth: ______/________/__________ 3. Sex: ______________________________________________

4. District / Agency of Domicile: _____________________ Date of Issue of Domicile: ____________________________

5. Fathers Name: ____________________________________________________________________________________

6. Present Postal Address: ______________________________________________________________________________

_________________________________________________________________________________________________

7. Permanent Address: ________________________________________________________________________________

_________________________________________________________________________________________________

8. Phone No (s) Res: ________________ Cell: __________________ e-mail: __________________________________

9. Have you ever been admitted / studying in any Medical/Dental College in Pakistan. If Yes, mention name of the

college: ____________________________________________________________________________________

10. Are you Hafiz-e-Quran Yes No

11. EDUCATIONAL QUALIFICATION:

Qualification Year Annual Roll No Marks Total Attempt Board / University

Passing / Supply Obtained Marks (s)
S.S.C (Science or equivalent
F.Sc (Pre-Medical) or
Equivalent
12. ETEA MEDICAL ENTRANCE TEST 2017
Entry Test ID __________________ Marks Obtained _________________ Percentage__________________________
13. Application Processing Fee: Rs. Bank Draft No: _________________________________________
Bank Name: _______________________________________________________ Dated:__________________________
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FOR OFFICE USE ONLY:
Receipt No. Dated: Office Stamp: __________________

1
REMARKS/DEFICIENCIES

ADJUSTMENT OF MARKS
Hafiz-e-Quran SSC 10% F.Sc 40% Entry Test 50%
Deduction Merit Score
Marks Weightage Weightage Weightage

Checked by Member of Scrutiny Committee ________________ Chairman Scrutiny Committee ___________________________

14. Were you ever involved in criminal proceeding in a court of LAW? If Yes, attach brief account ____________________
15. Name of School from where SSC Passed ________________________________________________________________
16. Name of College from where F.Sc Passed _______________________________________________________________

Signature of the Applicants Father/Guardian Signature of the Applicant

CNIC No: CNIC No or Registration No of Computerized Form B
- - - -

IMPORTANT NOTES / INSTRUCTIONS

1. Applications should reach the office of the Principal KMU-Institute of Medical Sciences, Kohat Development Authority
(KDA), Kohat on or before the closing date and time. Applications received after the due date and time will not be
entertained for admission.
2. Original bank draft of Rs: 2,500/- as application processing fee shall be remitted in the name of Treasurer Khyber
Medical University, Peshawar and must be attached with application form.
3. Candidate not having domicile of KP are not eligible to apply for admission on Khyber Pakhtunkhwa seats.
4. All applicants must appropriately fill and sign the admission form incomplete forms in any respect will not be accepted.
Avoid overwriting / cutting while filling the form.
5. Applicant must study the Admission Policy of KMU and the Prospectus in order to understand the Rules and Regulations
regarding, admission procedure, distribution of seats, examination / tuition fees etc.
6. Application forms with any false statement, the candidate will be rejected.
7. The following documents must be attached with the application form in the following sequence.
The documents & certificates must be attested by Gazetted Officer. The stamp of the officer must bear full name,
designation and current place of duty.
a. 01 copy of Secondary School Certificate Examination (Science /equivalent).
b. 02 copies of detailed Marks Certificate of examination on the basis of which admission is sought. (F.Sc or
equivalent).
c. An equivalence certificate from the Inter-Board Committee of Chairmen, Islamabad, if the qualifying certificate is
from an Institute abroad.
d. 01 copy of Computerised National Identity Card / Computerised Form-B of the candidate. (See instructions in the
prospectus.
e. 01 copy of computerized National Identity Card of the father of the applicant. (See above column-d) if the father is
not alive, then a copy of the National Identity Card of the mother / guardian.
f. 02 copies of the domicile certificate as mentioned in the entry test form.
g. 01 copy of Domicile certificate of the father of the applicant. If the father is not alive, then the death certificate of the
father issued by the municipal authority / hospital along with the domicile certificate of the mother showing clearly
her spouse name, have to be submitted. In case the spouse name is not written in the mothers domicile certificate
then domicile certificate of the brother may be submitted. A guardianship certificate shall also be submitted in such
cases [specimen of guardianship certificate is given at the end of prospectus].
h. 03 passport size coloured photographs of the applicant with name, father name, and attestation on the back.
i. 01 copy of Hafiz-e-Quran certificate if the candidate claims to be Hafiz-e-Quran.
j. 01 copy of certificate of location of educational institute only by FATA-IN as per specimen in the prospectus.
k. 01 copy of affidavit and undertaking regarding completion of study in KIMS as per specimen in the prospectus. Only
for admitted students at the time of admission.