NOTE: PLEASE NOTE THI S FORM I S FREE OF COST
PAKI STAN NURSI NG COUNCI L
National I nstitute of Health, I slamabad.
Tel: 051- 9255119, Fax: 051- 9255097
Email: regist_pnc@Hotmail.com, website: www.pnc.org.pk
Photo
REGI STRATI ON FORM 3x 3.5 cm
Registration No.
(For office use only)
Please fill in with CAPI TAL (BLOCK) letters. Tick where applicable
Section 1 ( Personal I nformation)
Full Name
Name on Matric Certificate
Daughter of/ Wife of/ Son of
Gender Male Female Date of Birth Day Month Year
Marital Status Single Married Other
(Specify)
NI C No. Passport No.
Place of Birth Religion
Nationality Domicile
Country Province Division
Section 2 ( Contacts)
Present Address Permanent Address
City City
District District
Division Division
Province Province
Country Country
Phone No. Fax No. Phone No. Fax No.
Email Address Mobile No.
Section 3 ( Ever Register)
Have you ever registered w ith PNC? Tick where applicable Yes No
I f yes then give Serial No and Registration No.
Serial No.
(Specify)
Registration No.
(Specify)
Section 4 ( Registration Category)
Qualification for w hich registration is desired. Tick where applicable
NAI D/ Dai Midw ife LHV Nurse Auxiliary
Section 5 ( Board I nformation)
Name of Nursing Examination Board from w hich Qualification/ diploma/ certificate w as issued.
Tick where applicable
Sindh Punjab NWFP Balochistan (Specify)
Section 6 ( Academic Qualification) Tick where applicable
Qualification Passing year I nstitution Board / University
Matriculation
FA / FSc / I CS
BA / BSc / B.com
MA / MSc
Other (s)
Section 7 ( Professional Qualification)
Period
Qualification I nstitution Board / University
From To
NAI D/ Dai
Midwifery
LHV
Nursing
BScN
MScN
PhD Nursing
Other Than Nursing
Section 8 ( Specialties)
Period
Specialty ( s) I nstitution/ Organization
From To
(Specify)
(Specify)
(Specify)
(Specify)
(Specify)
(Specify)
Section 9 ( Current Job)
Are You Currently Employed? Tick where applicable Yes No
Section 10 ( I n case of Currently Employed)
Employer Type : Government Private Semi Government Armed Forces NGO
Name and address of the I nstitution / Employer
Designation
City District Division
Province Country
I n w hich type of I nstitution / Organization are you w orking presently?
(Specify)
Section 11
I hereby certify that the information contained in this application is true and correct.
Certified By
(Necessary Only for initial registration)
Applicant’s Signature
(This SPECI MEN SI GNATURE will appear on Your Registration
Date Card. Please sign inside the box without touching lines.)
