APPLICATION FORM Reg. No.

To be Filled by NTS

MINISTRY OF NATIONAL HEALTH Picture 1

SERVICES, REGULATIONS & Paste your recent
NTS COORDINATION passport size color
photograph with gum

Screening Test to be for

Admission in MBBS / BDS

01. Bank Online Deposit of Rs: 650/- from Designated Bank Branches.
Bank Code Deposit Date

*Note: Application Form will not be entertained without Original Deposit Slip (NTS Copy)

02. Desired College/ Institution: Please fill one or more boxes for the desired colleges / institutions - MANDATORY
Federal Medical and Dental College – FMDC
01. (A public sector Medical & Dental College affiliated with 02. Shifa College of Medicine, Islamabad.
Shaheed Zulfiqar Ali Bhutto Medical University) Islamabad

03. Islamabad Medical & Dental College, Islamabad 04. Yusra Medical & Dental College, Islamabad

05. Rawal Institute of Health Sciences, Islamabad 06. Fazaia Medical College, Islamabad

07. Al-Nafees Medical College, Islamabad 08. Islamic International Dental College, Islamabad

Foundation University College of Medicine & Dentistry, HBS Medical and Dental College, Islamabad
09. 10.
Islamabad.

03. Desired Test City: Fill Only One Box (Mandatory)

Subject to a minimum of 200 candidates, otherwise the candidates will be assigned next nearest test city.

01. Isb/Rwp 02. Lahore 03. Faisalabad 04. Multan 05. Karachi

06. Hyderabad 07. Sukkur 08. Abbottabad 09. Peshawar 10. Quetta

11. Muzaffarabad 12. Gilgit

04. Province of Domicile: Please see your Domicile Certificate and then fill Only One Box (Mandatory)
01. Federal 02. Punjab 03. Khyber Pakhtunkhwa 04. Balochistan

05. Sindh (Urban) 06. Sindh (Rural) 07. AJK 08. Gilgit Baltistan

09. FATA

05. District of Domicile: Write Domicile of District Code & Name (Mandatory) District Code List given on last page.

District Code District Name

Personal Information: Use CAPITAL letters and leave spaces between words.
06. Name in Full:

07. Father’s Name:

08. Candidate CNIC #:
Write your own CNIC No. Or B Form No.

10. Date of Birth: D D M M Y Y

09. Gender: Male Female Write your Correct Date of Birth
otherwise you will be rejected 1 9
11. Postal Address:
All correspondence will be made on this address though courier service or ordinary postal service.

City: District:

12. Phone No: (OFF) (RES.) (Mobile)

City Code - Phone No Mandatory

13. Is your Father or Mother Federal Government Employee? Yes No

14. What is the status of your result of HSSC / ‘A’ Level Examination? Result Awaited Result Declared

15. Academic Information:

Note: 1. NTS will not issue Roll No Slips to those who have not filled in their academic record properly.
2. Candidate should convert their grades into marks. (O Level / A Level or any other degree having grade).
3. Write exact degree name & major subject mention in certificate / transcript.
4. Result awaited candidates can also apply subject to provision of result before admission in the relevant college.

Certificate / Specialization / Year

Degree Title Obtained Marks / CGPA Total Marks / CGPA Board / University / Institute
Degree Name Major Subject Passing

SSC / O Level
(10 Years)

HSSC / A Level
(12 Years)

Undertaking By The Applicant:

I_____________________________ d/s/w of _________________________do hereby solemnly
declare and affirm that I have read and understood the instructions and conditions for appearing in
Picture 2
the NTS Test as elaborated on NTS website and I have filled-up the application form as per Affix your recent
instructions given below. In case, any information contained herein is found at any stage to be passport size color
missing, untrue or false, my candidature can be cancelled at any stage (even after admission, if so photograph
revealed), and I shall be liable to legal action.
with Stapler

Date: _________ Thumb Impression ____________ Candidate’s Signature ________________

Ø
Please fill the Application Form properly with complete and correct information / answers.
Ø
Please DO NOT leave any field blank, otherwise your application may not be considered.
Ø
Incorrect, false or forged information may result in cancellation of your candidature at any stage, even after employment,
and also proceeding of a legal action.
Ø
Attach your Two recent Passport Size Photographs, Copy of CNIC and Original Bank Deposit Slip (NTS Copy)
Ø
By Hand submission of Application Form is not allowed.
Ø
Mobile Phones or any Electronic Gadgets are not allowed in Test Center premises.
Last date for submission of application form is Monday
Ø 26th September, 2016.

Please Send Application Forms to:

HELP LINE:
MNHS - R&C (Project)
UAN : +92-51-844-444-1
Website : www.nts.org.pk National Testing Service
1-E, Street No. 46, Sector I-8/2, Islamabad.
District of Domicile: (Please Do not attach this page.)
01. Federal:
Code District
101 Islamabad

02. Punjab:
Code District Code District Code District Code District
201 Attock 210 Gujrat 219 Lodhran 228 Rahim Yar Khan
202 Bahawalnagar 211 Hafizabad 220 Mandi Bahauddin 229 Rajanpur
203 Bahawalpur 212 Jhang 221 Mianwali 230 Rawalpindi
204 Bhakkar 213 Jhelum 222 Multan 231 Sahiwal
205 Chakwal 214 Kasur 223 Muzaffargarh 232 Sargodha
206 Chiniot 215 Khanewal 224 Nankana Sahib 233 Sheikhupura
207 Dera Ghazi Khan 216 Khushab 225 Narowal 234 Sialkot
208 Faisalabad 217 Lahore 226 Okara 235 Toba Tek Singh
209 Gujranwala 218 Layyah 227 Pakpattan 236 Vehari

03. Khyber Pakhtunkhwa:

Code District Code District Code District Code District
301 Abbottabad 308 Hangu 314 Lower Dir 320 Shangla
302 Bannu 309 Haripur 315 Malakand 321 Swabi
303 Battagram 310 Karak 316 Mansehra 322 Swat
304 Buner 311 Kohat 317 Mardan 323 Tank
305 Charsadda 312 Kohistan 318 Nowshera 324 Tor Ghar
306 Chitral 313 Lakki Marwat 319 Peshawar 325 Upper Dir
307 Dera Ismail Khan

04. Balochistan:
Code District Code District Code District Code District
401 Awaran 409 Kachi (Bolan) 417 Lasbela 425 Pishin
402 Barkhan 410 Kalat 418 Lehri 426 Quetta
403 Chagai 411 Kech (Turbat) 419 Loralai 427 Sherani
404 Dera Bugti 412 Kharan 420 Mastung 428 Sibi
405 Gwadar 413 Khuzdar 421 Musakhel 429 Sohbatpur
406 Harnai 414 Killa Abdullah 422 Nasirabad 430 Washuk
407 Jafarabad 415 Killa Saifullah 423 Nushki 431 Zhob
408 Jhal Magsi 416 Kohlu 424 Panjgur 432 Ziarat

05. Sindh:
Code District Code District Code District Code District
501 Badin 507 Kambar & Shahdadkot 513 Matli 519 Sukkur
502 Dadu 508 Karachi 514 Mirpurkhas 520 Tando Allahyar
503 Ghotki 509 Kashmore 515 Naushahro Firoze 521 Tando Muhammad Khan
504 Hyderabad 510 Khairpur 516 Sanghar 522 Tharparkar
505 Jacobabad 511 Larkana 517 Shaheed Benazirabad 523 Thatta
506 Jamshoro 512 Matiari 518 Shikarpur 524 Umerkot

06. Azad Jammu & Kashmir:

Code District Code District Code District Code District
601 Bagh 604 Haveli 607 Muzaffarabad 609 Poonch
602 Bhimber 605 Kotli 608 Neelum 610 Sudhnati
603 Hattian 606 Mirpur

07. FATA / PATA:

Code District Code District Code District Code District
701 Bajaur Agency 705 North Waziristan Agency 709 FR Dera Ismail Khan 713 FR Tank
702 Khyber Agency 706 Orakzai Agency 710 FR Kohat 714 PATA
703 Kurram Agency 707 South Waziristan Agency 711 FR Lakki Marwat
704 Mohmand Agency 708 FR Bannu 712 FR Peshawar

08. Gilgit Baltistan

Code District Code District Code District Code District
801 Astore 804 Ghizer 807 Kharmang 810 Skardu
802 Diamer 805 Gilgit 808 Nagar
803 Ghanche 806 Hunza 809 Shigar
 Building Standards in Educational and Professional Testing Building Standards in Educational and Professional Testing

MINISTRY OF NATIONAL HEALTH SERVICES, MINISTRY OF NATIONAL HEALTH SERVICES,

REGULATIONS & COORDINATION REGULATIONS & COORDINATION

Branch Code: Date: Branch Code: Date:

Branch Name: Branch Name:

ONLINE DEPOSIT SLIP
(* Please deposit fee in only one bank & tick the relevant bank)

Allied Bank Limited Muslim Commercial Bank Allied Bank Limited Muslim Commercial Bank
(Formely: Allied Bank of Pakistan Limited) (Formely: Allied Bank of Pakistan Limited)

Remote Remote Remote Remote

Branch: I-8 Markaz Branch Islamabad (0140947) Branch: I-8 Markaz Branch, Islamabad (1501) Branch: I-8 Markaz Branch Islamabad (0140947) Branch: I-8 Markaz Branch, Islamabad (1501)
A/C A/C A/C A/C A/C A/C A/C A/C
Title: NTS-Pakistan-Collection No. 0010008325640018 Title: NTS-Pakistan 647943831003775
No. Title: NTS-Pakistan-Collection No. 0010008325640018 Title: NTS-PakistanNo. 647943831003775
Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost

LTD LTD
THE POWER TO LEAD THE POWER TO LEAD
Remote Remote
Branch: Cantt Br Kashmir Road Rawalpindi (0041) Remote H9 Shalimar Recording Co ISB (1742)
Branch: Cantt Br Kashmir Road Rawalpindi (0041) Remote H9 Shalimar Recording Co ISB (1742)
Branch: Branch:
A/C A/C A/C A/C A/C A/C A/C A/C
Title: NTS- Pakistan No. 217767828 Title: NTS-Pakistan No. 17427900464503 Title: NTS- Pakistan No. 217767828 Title: NTS-Pakistan No. 17427900464503
Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost Note: Bank Service Charges Free of Cost
*Note: Desired Bank Stamp is required on the Deposit Slip & Send Original *Note:
Deposit Slip (NTS Copy) along Application Form to NTS Office 1. Please Stamp both copies of deposit Slip.
a 2. The Bank Must Return “NTS Copy” to the Candidate.
Application Form will not be entertained without Original Deposit Slip (NTS Copy) 3. Deposit Slip will not accepted without Candidate CNIC/ B Form No.

Applicant’s Applicant’s
Name: Name:
Father Father
Name: Name:
CNIC No/ CNIC No/
B Form No: B Form No:

Amount Amount in Six Hundred & Fifty Rupees Only Amount 650/- Amount in Six Hundred & Fifty Rupees Only
Rs:
650/- word: Rs. Rs: word: Rs.
Non Refundable/ Non Transferable Non Refundable/ Non Transferable

Applicant Signature Cashier Officer Applicant Signature Cashier Officer