S.

No _______________ Form -A

Qurtuba University of Science & Information Technology, D.I.Khan

Paste one recent

Application for Admission to B.Sc. Electrical /Civil Engineering Degree Program passport size
photograph
(ACADEMIC SESSION 2020-2021 Onwards) here, duly
attested gazette
officer on face
Personal Information: side
(Block Letters)
Name (As in Matric Certificate) _____________________________________Father Name:___________________________

Present Postal Address__________________________________________________________________________________

____________________________________________________________________________________________________
Home Phone (with area code)_________________________________Mobile_____________________________________
(Please keep your mobile phone “on” for possible contact)

E-mail_______________________________________________ Emergency Contact _______________________________

Academic Record:
Annual/ Marks Total
Examination Year Roll No Name of Board %age
Supplementary obtained Marks
Matric Examination
*Equivalent Examination
(If applicable) please name

Intermediate Part-I
Intermediate Part-II
*Equivalent Examination
(If applicable) please name

*An equivalence/marks conversion certificate issued by the Inter Board Committee of Chairman, Government of Pakistan, Ministry of Education,
Islamabad, for candidate having passed Equivalent examination from an institution outside Pakistan.

1. Have you passed any of the Intermediate Examination (Part I to Part II) in more than one attempt? Yes No
If yes, how many attempts Part I______________Part II______________ (Please attach old DMC)
2. Have you improved your marks in the intermediate Examination? Yes No (Please attach old DMC)
3. Have you passed Additional Mathematics in place of Biology? Yes No (Please attach old DMC)
If yes, marks in Biology __________________marks in Additional Mathematics ____________
4. Are you Hafiz-e-Quran? Yes No

5. Are you currently a student of Qurtuba University? Yes No

ETEA Entrance Test 2015-2016

Entrance Test ID Total Marks Marks Obtained Percentage Marks

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 Order of Discipline Preference
Please prioritize discipline (from amongst Civil and Electrical Engineering) in order of preference in the table below:

Preference Discipline

Choice No. 01

Choice NO. 02

Admission shall be considered strictly on the basis of choices exercised by the candidate. No change in choice of discipline
shall be allowed after submission of the application.

________________
Applicant Signature
Name_______________________________
F/Name _____________________________
CNIC or Registration No. of Form CRC

- -

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FOR OFFICE USE ONLY
(ADJUSTMENT OF MARKS)
SSC Intermediate Entrance Test Hafiz-e-Quran Biology Addl. Maths

DEDUCTIONS
Improvement of Division Additional Attempts Additional Mathematics

Adjusted Marks

Admission Committee Recommendations

Name (Member Admission Committee) Recommendations Signature

_________________________ _____________________________ _________________
_________________________ _____________________________ _________________
_________________________ _____________________________ _________________

Admitted Provisionally Admitted Discipline Allotted____________________________

Not Admitted Reason_________________________________________________________

_____________________ __________________ ________________________

Chairman of the Deptt. Registrar/Add. Registrar Director Admissions
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Applicant Declaration:

I hereby affirm that all entries made in this application are true and correct to the best of my knowledge and belief that I
have read the conditions of Admission Regulations as outlined in the Undergraduate Prospectus 2015-2016 thoroughly,
and promise to abide by the rules/regulations of the University enforced at present or to be framed subsequently.
I hereby solemnly affirm that in case I am admitted, I shall not indulge in political activities, organize or be part of any
student association, union and federation, except those allowed by the University.
I solemnly declare that I will not seek admission in any other institution in the country.

________________
Applicant Signature

Name _________________________________________________F/Name _______________________________________

Contact No.___________________________________________
CNIC or Registration No. of Form B

Father /Mother/Guardian Declaration

I certify that my son/daughter/ward is applying for admission with my knowledge and consent, and that I hold myself
responsible for his good conduct and his financial liabilities. I hereby solemnly affirm that in case my son/daughter/ward
Mr./Ms____________________________________________is admitted, he/she shall not indulge in political activates,
organize or be part of any student association, union and federation, except those allowed by the University.
I hereby agree that in the event of any injury, damage or loss resulting from any cause whatsoever, directly or indirectly, to
my son/ daughter/ ward during the course of his/her studies/training in the University, at any place in Pakistan, I my
son/daughter/ward, and our heirs, shall have no claim whatsoever, pecuniary or otherwise, against the University.

________________
Signature of Father/Mother/Guardian

Name _________________________________________________F/Name _______________________________________

Contact No.___________________________________________Relation with Candidate ____________________________
CNIC

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 Undertaking

I,________________________________________ Son/Daughter of __________________________________________

Provisionally admitted in ____________________________department hereby undertake that I am satisfied with the
discipline allocated to me and do not want to be transferred to other discipline during the process of adjustment of seats.

_______________________________ _______________________
Signature of Father/Mother/Guardian Candidate’s Signature

Name _________________________ Date: _______________________

Relation with candidate _______________________________
CNIC - -

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Instructions for Applicants
• Application for Admission, complete in all respect, must reach the Office of Admission, Qurtuba University of Science &
Technology D.I.Khan, on or before the last date announced in the newspapers. Applications received after the closing date
shall not be entertained.
• Incompletes applications shall not be considered.
• Documents once submitted with the application form cannot be changed and shall be considered as final.
• Any certificate regarding revision of result/improvement of marks etc. received after admission shall not be accepted.
• Application form found with “False Statement” shall be rejected.
• Candidates asked to report for interview and admission should bring with them original documents, and prescribed fee.
• Hafiz-e-Quran candidates are advised to appear before the Admission Committee for Oral Test on the date and time, notified
by the University, No separate call letters will be issued.

Check List

Legible attested copies of following documents are required with this application form (selected candidates will have to submit the
original documents at the time of interview/admission). Tick √ Appropriate box YES NO NA
1. Detailed Marks Certificate of SSC.
2. Detailed Marks Certificate of intermediate Part-
3. Detailed Marks Certificate of Intermediate Part-II
4. Detailed Marks Certificate of Additional Mathematics (if applicable)
5. Original/Provisional Certificate of Matric
6. Hafiz-e-Quran Certificate from a recognized institution
7. Domicile certificate of the Candidate (Which was submitted with the ETEA Test Form)
8. Detailed Marks Certificate of Diploma of Associate Engineer, (All examinations)
9. Father’s/Mother’s/Guardian’s Computerized National Identify Card (copied on full size paper)
10. CNIC of Candidate or Children Registration Certificate (CRC) (copied on full size paper)
11. Five recent passport size and passport style colored photographs
12. Good Character Certificate from the institution last attended
13. ETEA Test Result
14. Engineering Qualifying aptitude results (if applicable)

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