Student Name: QURAT UL AIN Program: MBBS

Code: MB9736812 Cell: 923006002414

Personal Info
First Name : QURAT Last Name : UL AIN

DOB : Blood Group :

Email : CNIC/Form B/Passport :

Domicile District : Landline # :

Primary Mobile # : 923006002414 Secondary Mobile # :

Gender : Male Marital Status :

Religion : Nationality :

Permanent Address
P/o Chah Modi Wala DD Panah Kot Addu, Kot Addu, Kot Addu, Punjab, Pakistan, 34050

Mailing Address

Parent Detail
Relationship :Father

Name : MUHAMMAD AZHAR

CNIC/Passport :

Email :

Landline # :

Primary Mobile # : 923006002414

Secondary Mobile # :

Occupation / Profession :

Company / Office Name :

Company / Office Address :

Emergency Contact
Contact Name : Relation with Student :
Landline # : Email :
Mobile # : Address :

I.T Department, RMCS Page 1 of 3

Student Name: QURAT UL AIN Program: MBBS
Code: MB9736812 Cell: 923006002414

Academic Detail

I.T Department, RMCS Page 2 of 3

Student Name: QURAT UL AIN Program: MBBS
Code: MB9736812 Cell: 923006002414

Other Detail
Applicant Type :

Hostel Accommodation : Not Required

Transportation : Not Required

Appear in Interview : No

Reference 1 :

Reference 2 :

Declaration by the Applicant and Parent

I have read the application form and I am fully aware of the details of the teaching program. If granted admission, I undertake to
pay the fees and all other dues regularly and without delay. I also undertake to abide by the rules and regulations of the College. I
further certify that the information provided in the application form is true to the best of my knowledge. I fully understand that no
partial or total refund is allowed at all after the deposit of the college fee, except as instructed by PMC/UHS.

I agree

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