* | Medical School Rel Ri ECFM Medical School Release equest Please complete, sign, and date this form. This form must be sent to ECFMG with your medical education credentials. QUAID E AZAM MEDICAL COLLEGE ‘Name of Medical School CIRCULAR ROAD. ‘Address of Medical School BAHAWALPUR, PUNJAB, 63100 Gity, State/Province, Postal Code PAKISTAN Country Re: Name: NASIR. BILAL ‘Applicant Name — Last First ‘idele usmerecrme io no. [°)-f]/*]]-l*|1E]-(4 PHOTOGRAPH: Attach a current, full-face, Date of Birth: th Apri 1901 passportsized color Day 7 Monty photograph of yourself here Use tape or glue; no staples or Paper clips please, Date of Graduation Ari 2016 Month Ye ‘A photocopy of your photograph is not acceptable. Dear Sir or Madam |am currently applying to the Educational Commission for Foreign Medical Graduates (ECFMG"). To facilitate this process, | hereby request: * An official, final medical school transcript which bears your institution's seal and the signature of an authorized official; and + Cettiication of my Final Medical Diploma, by affixing the institution's seal and the signature of an authorized official nto the diploma; and + An authorized official of your Medical School to provide the requested information on my medical education. If you have any questions about this process, please contact ECFMG by e-mail at deansbox@ecimg.org. Thank you for your assistance. Sincerely, Signature of Ropeant 410th January 2015 Date of Signature Pogo Toft