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College of Physicians & Surgeons Pakistan

7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99266400-410 , Fax: 99266432, UAN: 111-606-606
Website: www.cpsp.edu.pk
Term:
11-OCT-2017

Online Application Form For FCPS-II (MAJOR SUBJECTS)

Appearing In: Clinical


Fee Type: Bank Challan Fee Amount: PKR 15050
Fee Submission City Islamabad
Receipt #: ISL-C-17-3131 Receipt Date: 12-06-2017
Bank Name: UNITED BANK LTD
Branch Name: G-8, Al Markaz Branch, Islamabad (0234)

Profile Information
CPSP ID: 2010-1075 Form No: 738-80955
Medical Reg. No: 51270-P
PMDC Issue/Exp. Date: 24-07-2007 ---- 31-12-2021
Repeater
Full Name: MUHAMMAD KAMRAN AFZAL
Father's Name: MUHAMMAD AFZAL
Nationality: Pakistan
Islamabad
Identity Card No: 37406-6241206-7
Date of Birth: 12-05-1984 SURGERY
Email: doktor.kamran@yahoo.com
Gender / Marital Status: Male / Married
SGR-2010-153-4718

Present/Mailing Address (Residential Only)


Address: C-751, LANE-14 LALA RUKH
Wah Cantt, Punjab, Pakistan
Tel (Res.): 0514-533418 Tel (Office):
Cell: 03345274578 Postal Code:

Permanent Address (Residential Only)


Address: C-751, LANE-14 LALA RUKH
Wah Cantt, Punjab, Pakistan
Tel (Res.): 0514-533418 Tel (Office):
Cell: 03345274578 Postal Code:

Particulars of Last Examination Appeared


Roll Number: 951909 Date of Examination: 12-04-2017
Enrolment: Center: Islamabad

Declaration
I do hereby declare that information given above is correct to the best of my knowledge. Incorrect information may lead to cancellation of enrollment /
admission / results and disciplinary action.

Signature of Candidate: ________________________________ Name: MUHAMMAD KAMRAN AFZAL


Dated: 12-06-2017

For quick and effective communication all correspondence with the candidates will be done through email rather than by postal means / courier.
Overwriting is not allowed on the hard copy of the application form nor any candidate is allowed to change his/her particular electronically.
Once entered in the application the center will only be changed after submission of prescribed fee fo this change.
Candidates are advised to attach a hand written application if they want to change their particulars.
If you have any problem then contact at this number: 021-99266400-410 Ext. 246 or email at fcps2a@cpsp.edu.pk.

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ORIGINAL - Concerned Department DUPLICATE - Applicant

Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2

College of Physicians and Surgeons Pakistan College of Physicians and Surgeons Pakistan

Bank Challan Bank Challan


Center: Islamabad RTMC No: SGR-2010-153-4718 Center: Islamabad RTMC No: SGR-2010-153-4718

Receipt #: ISL-C-17-3131 Receipt Date: 12-06-2017 Receipt #: ISL-C-17-3131 Receipt Date: 12-06-2017

Name: MUHAMMAD KAMRAN AFZAL Name: MUHAMMAD KAMRAN AFZAL

Form No: 738-80955 Form No: 738-80955

Fee Type Session Amount Fee Type Session Amount

Exam Fee - FCPS-II OCT-2017 PKR 15050 Exam Fee - FCPS-II OCT-2017 PKR 15050

Total: PKR 15050 Total: PKR 15050

Amount in words: Fifteen Thousand and Fifty Only (PKR) Amount in words: Fifteen Thousand and Fifty Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________


Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

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TRIPLICATE - CPSP Finance QUADRUPLICATE - Bank

Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2

College of Physicians and Surgeons Pakistan College of Physicians and Surgeons Pakistan

Bank Challan Bank Challan


Center: Islamabad RTMC No: SGR-2010-153-4718 Center: Islamabad RTMC No: SGR-2010-153-4718

Receipt #: ISL-C-17-3131 Receipt Date: 12-06-2017 Receipt #: ISL-C-17-3131 Receipt Date: 12-06-2017

Name: MUHAMMAD KAMRAN AFZAL Name: MUHAMMAD KAMRAN AFZAL

Form No: 738-80955 Form No: 738-80955

Fee Type Session Amount Fee Type Session Amount

Exam Fee - FCPS-II OCT-2017 PKR 15050 Exam Fee - FCPS-II OCT-2017 PKR 15050

Total: PKR 15050 Total: PKR 15050

Amount in words: Fifteen Thousand and Fifty Only (PKR) Amount in words: Fifteen Thousand and Fifty Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________


Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

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