Form No: 380161

Session: Fall 2019

Faculty: Faculty of Science

Name: Mashal Gulraiz

Father's Name: Gulraiz Ahmed
Date of Birth: 10 May 2000 Undergraduate
CNIC: 81204-0571585-2
Gender: Female Admission Form
Mobile: 0346-0181691
Domicile AJK
District Kotli
Type
Nationality: Pakistani
Address Details:
Mailing Address P/O BALL DAMAS TEHSIL CHARHOI DISTRICT KOTLI,Kotli
Permanent Address P/O BALL DAMAS TEHSIL CHARHOI DISTRICT KOTLI,Kotli

Education Details:
Degree Board / Univ Subjects Total Marks Obtained Marks
SSC SSC AJK BISE Mirpur SCIENCE 1100 860
HSSC FSC AJK BISE Mirpur PRE_MEDICAL 505 413

Entry Test Result:

Test Group Total Marks Marks Obtained Status
Undergrad Science 500 230

Program Choices:
Program Preference Cost

AJ&K National (Subsidized) 0

BS Biotechnology 3 0
BS Chemistry 1 300
BS Zoology 2 300
Open Merit (Self Finance) 300
BS Chemistry 1 300
BS Zoology 2 300
Total Cost: 1500

Fee Deposited vide challan no. Dated. Amount. Rs. 1500

Declaration: I declare that incorrect information will disqualify me for admission.

Signature of the applicant: Date:

 UNDERTAKING
[to be submitted by the selected candidates only]
(This undertaking shall be submitted on a judicial stamp paper of Rs. 20/-)
(Part - 01: To be filled by the student)
I, Mr. / Ms. Mashal Gulraiz Son / Daughter of Mr.Gulraiz Ahmed provisionally selected for admission for the session Fall 2019 at
the Mirpur University of Science and Technology, Mirpur, (A.K) do solemnly declare that:

1. The documents submitted by me are actually issued by the Board / University / Magistrate / Director NCC as entered in
Admission Form. These documents are not false / fake / bogus / fabricated.
2. I have not been rusticated / expelled from any institution of learning (including school / college / polytechnic institute / university
etc.) during my previous career, nor I am at present debarred from taking examinations at other institutions of learning, nor am
I currently suspended due to any reason at other institution of learning.
3. I will have no direct / indirect affiliation with any political party, and during my stay in the University I shall not indulge in the
politics.
4. I shall obey all rules and regulations of the University.
5. The information presented by me at 1, 2, 3, and 4 above and in my application form along with the documents enclosed is
correct to the best of my knowledge and if anything contrary is found, I may be expelled from the University without any notice.

Dated: Signature:

Address:

Witness No: 01 Witness No: 02

Signature: Signature:
Name: Name:
Address: Address:

CNIC No: CNIC No:

(attach attested photocopy of CNIC) (attach attested photocopy of CNIC)

(Part - 02: To be filled by father / guardian of the student)

I, Mr. Ms. son/daughter/wife/widow of Mr. Father/guardian of Mr. / Ms. Mashal
Gulraiz have read the above undertaking. I do hereby affirm to be responsible for his / her behaviour during his / her stay at the
University. In case he / she violates the above undertaking or the rules and regulations of the University, I shall have no objection to
his / her expulsion from the University.
Dated: Signature:

CNIC No:

Address:

Witness No: 01 Witness No: 02

Signature: Signature:
Name: Name:
Address: Address:

CNIC No: CNIC No:

(attach attested photocopy of CNIC) (attach attested photocopy of CNIC)

Attested by Magistrate First Class

 MEDICAL CERTIFICATE
[to be submitted by the selected candidate only]
No. : Dated:
Application No. : Place of Issue:

Name of Candidate :
Photograph of
the candidate Father's Name :
Sex : Date of Birth:
Identification Marks :

Medical Examination
Type of Examination Results
R. Eye
Vision
Eye L. Eye
Color Vision
R. Ear
Ear
L. Ear
Chest X - Ray
B.P.
Heart
Systematic Examination
Lungs
Abdomen
Hernia
Extremities
Others
Varicose Veins
Skin
Veneral Diseases: Clinical:

Neurological / Psychiatric evaluation

Laboratory Investigation
Type of Examination Results
Sugar
Urine
Albumin
Stool Routine Examination
C/P Blood with ESR
HIV / HBV / HCV
History of Past Illness
Any history of admission in hospital more than ten days Yes / No Syncope Yes / No
Epilepsy Yes / No Asthma Yes / No
D. M. Yes / No Tuberculosis Yes / No
PU Yes / No Hydrocele Yes / No
IHD Yes / No Hernia Yes / No
Stroke Yes / No Vericocele Yes / No
Operation Yes / No Foreign Visit Yes / No
Blood Transformation Yes / No Vaccinated Yes / No
Remarks

Counter Signed by: Signature & Official Seal:

Medical Superintendent, DHQ Civil Medical Officer
 Mirpur University of Science and Mirpur University of Science and Mirpur University of Science and Mirpur University of Science and
Technology, Azad Kashmir Technology, Azad Kashmir Technology, Azad Kashmir Technology, Azad Kashmir

ADMISSION PHASE 2 FEE ADMISSION PHASE 2 FEE ADMISSION PHASE 2 FEE ADMISSION PHASE 2 FEE
BANK COPY ACCOUNT COPY ADMISSION OFFICE COPY STUDENT COPY
Fall 2019 Undergraduate / Graduate Program Fall 2019 Undergraduate / Graduate Program Fall 2019 Undergraduate / Graduate Program Fall 2019 Undergraduate / Graduate Program

A/C No: A/C No: A/C No: A/C No:

0010050686280021 0010050686280021 0010050686280021 0010050686280021
Challan # 192023801611891 Challan # 192023801611891 Challan # 192023801611891 Challan # 192023801611891
Admission Form # 380161 Admission Form # 380161 Admission Form # 380161 Admission Form # 380161
Name: Mashal Gulraiz Name: Mashal Gulraiz Name: Mashal Gulraiz Name: Mashal Gulraiz
Faculty Science Faculty Science Faculty Science Faculty Science
Due Date 17th Sept, 2019 Due Date 17th Sept, 2019 Due Date 17th Sept, 2019 Due Date 17th Sept, 2019

Cash: 1,500 Cash: 1,500 Cash: 1,500 Cash: 1,500

Total Payment (Cash) Rs: Total Payment (Cash) Rs: Total Payment (Cash) Rs: Total Payment (Cash) Rs:
(One Thousand Five Hundred (One Thousand Five Hundred (One Thousand Five Hundred (One Thousand Five Hundred
Rupees Only.) Rupees Only.) Rupees Only.) Rupees Only.)

Overwriting will Not be accepted.
Application Form will not be entertained
without Original Deposit Slip (Admission
office Copy) with original Bank stamp.
This Fee is Non-Refundable / Non
Transferable in any case.
Overwriting will Not be accepted.
Application Form will not be entertained
without Original Deposit Slip (Admission
office Copy) with original Bank stamp.
This Fee is Non-Refundable / Non
Transferable in any case.
Overwriting will Not be accepted.
Application Form will not be entertained
without Original Deposit Slip (Admission
office Copy) with original Bank stamp.
This Fee is Non-Refundable / Non
Transferable in any case.
Overwriting will Not be accepted.
Application Form will not be entertained
without Original Deposit Slip (Admission
office Copy) with original Bank stamp.
This Fee is Non-Refundable / Non
Transferable in any case.

Bank Stamp Bank Stamp Bank Stamp Bank Stamp

Allied Bank Ltd. Main Branch Bank Allied Bank Ltd. Main Branch Bank Allied Bank Ltd. Main Branch Bank Allied Bank Ltd. Main Branch Bank
SQUARE Mirpur Azad Kashmir SQUARE Mirpur Azad Kashmir SQUARE Mirpur Azad Kashmir SQUARE Mirpur Azad Kashmir
Important Notice
After submission of Admission Form Application (Phase-II) please print the duly filled submitted application form and send, by post or deliver personally at following
address:
Admission Office Directorate of Students’ Affairs, Mirpur University of Science & Technology (MUST), Mirpur-10250, Azad Jammu and Kashmir
Due Date: 17th September, 2019 (Phase-II).

Required Documents:

Marks Certificates of qualifying examinations (All detail marks certificates of Matric/F.A/ B.A/ B.Sc./ B.Com/ M.A/ M.Sc./ M.S/ M.Phil/
BS or equivalent examination.
CNIC/ B-Form
Character Certificate (Last attended college/ University)
State Subject for AJK National, Kashmiries Refugees settled in Pakistan and Refugee 1989 and onward
Domicile
GAT (General) by NTS for MS/ M. Phil and GAT (Subject) by NTS for Ph.D Programs.
2 Recent Passport Size Photographs
Hafiz-e-Quran Certificate (if applicable)
Disable Certificates (only for those candidate who applied for disable quota seat)
The certificates duly signed by the Competent Authority of being a beneficiary under any of the reserved categories (if applicable)
Candidate finally selected for admission will be required to provide following document: Migration Certificate/ NOC, Undertaking duly
attested by First Class Magistrate, Medical Certificate duly attested by Civil Medical Officer and Medical Superintendent of DHQ.

** Documents received after the due/closing date of Admission Form Submission will not be entertained.