AHMAD MEDICAL INSTITUTE Form No. ______

Street Alfalah, Arbab Road Stop, Main University Road, Peshawar.

Ph. 091-5702201-2, Mob: 03350560499

Website: Email:

Diploma Courses:

1 / Anesthesia Technology / 2 (Yrs)
2 / Dental Technology / 2 (Yrs)
3 / Health Technology / 2 (Yrs)
4 / Medical Lab Technology / 2 (Yrs)
5 / Pharmacy Technology / 2 (Yrs)
6 / Surgical Technology / 2 (Yrs)

Please write your three (3) choices below from the above programs.

1______2______3______

(Fill in Capital Letters)

Applicant’s Name:

Applicant’s CNIC:


Father’s Name:

Father’s CNIC

Date of birth:Gender:

Marital Status:Single Married

Present address:………………………………………………………………………………………………………………

……………………………………………………………………………………......

Permanent address:District/Agency of domicile: …………………………. Province: ………..……………...... Nationality:

PhoneRes:…………………………………Cell:……………………………………..Email:………………………......

Guardian Name:……………………………… Guardian Profession: ……………………………………….…......

Guardian Contact No:..….………………………..………………………

In case of Emergency, contact (Peshawar)

(1) Name: ………………………………………

Address:…………………………………………………………………………...... …………………………..

Phone Res:………………………………………Cell:…………………………………………………………………..

(2) Name: ……………………………………… Address:…………………………………………………………………………...... …………………………..

Phone Res:………………………………………Cell:…………………………………………………………………

Do you have any medical experience Yes No

If yes then write down detail:______

Educational Information:

S.No / Passing
Year / Name Of Board / Exam Name / Annual/ Supply / Marks
Obtained / Total Marks / Exam Roll No / %age
1
2
3

1: Do you want to avail Hostel Facility: Yes No

2: Do you want to avail Transport Facility: Yes No

3: Were you ever convicted in criminal proceedings in a Court of Law? If yes, attach brief account.

Certified that the facts produced are correct to the best of my knowledge.

DECLARATION

I, hereby solemnly declare that the particular given above are correct. In case of any wrong information of fact, I shall be responsible for the consequences. I further under take to abide by all the rules and regulation of the institute and shall accept all the decision made by the institute’s administration.

Father/ GuardianSignature:______ApplicantSignature:______

NIC No:NIC No:

- / -
- / -

For office use only:

Eligibility:Eligible: Not Eligible:

Technology Allotted

Admission Granted Yes: No:

Dues paid vide receipt NoDated: //

Institute registration No:

Dealing Assistant:

Incharge Admission Committee:

Course Coordinator:

INSTRUCTIONS FOR APPLICANTS

Attach attested photocopies of the following documents with the application form in the following sequence. Tick ( ) in the relevant box for the attached documents.

Six recent passport size colored photographs of the applicant attested on the back side.

Two copies of Detailed Marks Certificate on the basis of which admission is sought (Matriculate)

An equivalency certificate, if the qualifying certificate is from a foreign country.

A copy of Secondary School Certificate Examination (Science)

Two copies of Domicile Certificate or a copy of Computerized National Identity Card of the candidate or Computerized Form B, copied on full size paper.

A copy of Computerized National Identity Card of applicant’s father or Guardian/ other, if father is not alive.

A copy of attempt certificate from the Concerned BISE, if the period between SSC and F. Sc. is more than two sessions.

ELIGIBILITY:

i.Metric with Science with at least 50% marks.

ii.Age Limit: 30 years

iii.In-Service Health Department age limit upto 35 years (service certificate , last pay slip is required)