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R. No. Form No.

(Office Use Only)

ARMED FORCES POSTGRADUATE MEDICAL INSTITUTE RAWALPINDI


ADMISSION FORM

NOTE: Photograph
The form shall be submitted to the Students Affairs Department, AFPGMI Rawalpindi
Please clearly print or type only in CAPITAL LETTERS.
Incomplete and incorrect admission form will not be entertained.

1. Full name in block letters:

2. Fathers/Husbands name in block letters:

3. Date of Birth (dd/mm/yyyy):


4. Gender M F

5. Nationality:

6. Degrees (Cross the relevant degree) MPH House Job


Dip Card Ph.D/M.Phil
7. District of Domicile:

8. Applicants NIC Number:

9. PMDC Registration No
10. Mailing Address (mention all relevant information like Street, Village etc):

11. Telephone Number (Present): 12. Mobile No:

13. E-mail:_________________________________________

-------------------------------------------------------------------------------------------------------------------------
ARMED FORCES POSTGRADUATE MEDICAL INSTITUTE RAWALPINDI
(For Official Use Only)

Name: _________________________ Fathers/Husbands Name: ______________________ Form no.

MPH Dip Card House Job Ph.D/M.Phil

Date: ____________ Received by: ________________


14. Permanent Address (mention all relevant information like Street, Village etc):

15. Telephone No. (With city code) Permanent:

16. Postgraduate Qualifications:

17. Year of Qualifying MBBS/BDS:

18. Name of Medical/Dental College from where graduated:

19. Presently Working at:

20. Documents to be attached: -


I have attached attested copies of the following documents with form (tick appropriate box)
Degree of MBBS/BDS Postgraduate Qualifications

NIC Experience Certificate

02 Photographs size (4 x 4 cm) PMDC Registration Certificate

Detail Marks sheet of each professional Experience Certificate from provincial /


examination federal government regarding service in
House Job Certificate BHUs / RHUs

21. Permission letter / NOC from concerned Dept/Institute/Hospitals for candidates serving in Public
sector.
CERTIFICATE BY THE APPLICANT

I hereby solemnly declare that the information provided and statements made by me in this form
are true and correct to the best of my knowledge and belief. I fully understand that any false statement of
mine shall render me liable for termination from the course.

Dated:
Signature