For Government Employees (Deputation)
CHECK LIST
POSTGRADUATE MEDICAL INSTITUTE, LAHORE
Course Applied For (Deputation)______Academic Year : 2017
Name of Candidate ______S/O, D/O ______
Sr. No. ______Diary No. ______Dated ______
INCOMPLETE APPLICATION WILL NOT BE ENTERTAINED
Make surethat you have attached the following attested documents sequence wise with your Application, otherwise your application will not be entertained for admission:-
1.Attached the Result of Entry Test by UHS conducted on 18.07.2016.
2.Copy of Matric/ FSc/M.B.B.S/ B.D.S/ MD Degree
3.Attempt Certificate from the Principal of the College Stating the number of attempts and marks obtained in each Profession examination of M.B.B.S/ B.D.S.
4.House Job Certificate with exact dates from the concerned Medical Superintendent. Testimonial of House Job from the Professor and Head of the Department is also required.
5.Service Experience Certificate at BHU, RHC THQ & DHQ along with Ist Appointment letter & Joining Report
6..Service certificates (Relevant Exp. Certificates as M.O/ Demonstrator etc.) from Medical Superintendent. Testimonial from the Professor and Head of the Department is also required.
7.Valid PM&DC Registration Certificate.
8.Copy of the Domicile & National Identity Card.
9.Please check that you have pasted 01 Photograph on the Admission Form.
10.Staple the Original Receipt of the Online transaction of Rs.1000/- in favour of the Principal, PGMI, Lahore (A/C No. PLS-4878-1 Bank of the Punjab, Jail Road, Lahore Branch Code: 0213) on the front page of application.
Received BySignature of the CandidateChecked By
………………………………………………………………………………………………………..
CHECK LIST (Deputation)
Course Applied For (Deputation)______Academic Year: 2017
Name of Candidate ______S/O, D/O ______
Sr. No. ______Diary No. ______Dated ______
INCOMPLETE APPLICATION WILL NOT BE ENTERTAINED
Make surethat you have attached the following attested documents sequence wise with your Application, otherwise your application will not be entertained for admission:-
1.Attached the Result of Entry Test by UHS conducted on 18.07.2016.
2.Copy of Matric/ FSc/M.B.B.S/ B.D.S/ MD Degree
3.Attempt Certificate from the Principal of the College Stating the number of attempts and marks obtained in each Profession examination of M.B.B.S/ B.D.S.
4.House Job Certificate with exact dates from the concerned Medical Superintendent. Testimonial of House Job from the Professor and Head of the Department is also required.
5.Service Experience Certificate at BHU, RHC THQ & DHQ along with Ist Appointment letter & Joining Report
6..Service certificates (Relevant Exp. Certificates as M.O/ Demonstrator etc.) from Medical Superintendent. Testimonial from the Professor and Head of the Department is also required.
7.Valid PM&DC Registration Certificate.
8.Copy of the Domicile & National Identity Card.
9.Please check that you have pasted 01 Photograph on the Admission Form.
10.Staple the Original Receipt of the Online transaction of Rs.1000/- in favour of the Principal, PGMI, Lahore (A/C No. PLS-4878-1 Bank of the Punjab, Jail Road, Lahore Branch Code: 0213) on the front page of application.
.
Received BySignature of the CandidateChecked By
POST GRADUATE MEDICAL INSTITUTE,
6- ABDUL REHMAN CHAUGHTAI ROAD, LAHORE
042-99202089 - 042-99202096
Web: pgmipunjab.edu.pk , E-mail:
ADMISSION FORM (DEPUTATION)
(ACADEMIC YEAR: 2017)
(FOR REGULAR EMPLOYEES OF PUNJAB GOVT, HAVING TWO YEAR GOVT. SERVICE EXPERIENCE TILL 20.09.2016)
NOTE: One application will be considered for only one course.
Course applied for ______
1.Name (Block Letters)______
2.Father’s Name ______
3.N.I.C. No. ______
4.Date of Birth ______
5.District of Domicile ______
6.Present Address ______
______
Tel/ Mobile. ______
Tel. / Mobile in Lahore ______
7. Permanent Address ______
Tehsil: ______Dist: ______
E-mail ______
8. Details of Online Transaction
Amount Paid Rs. ______Receipt No. ______
9. Qualification:
MBBS / BDS / MDa) Tick the relevant
Name of Medical/ DentalCollege ______
Country: ______
b).Postgraduate qualification if any______
Name of Institution Country ______
[
10. PMDC Registration: Valid Up-to ______
Page 1-3 (Deputation)
Page 2-3(Deputation)
11.Particulars of MBBS/BDS Marks
TITLE OF QUALIFICATION / Obtained Marks / Max. Marks / ATTEMPT / Conversion Formula for Academic MarksIst Prof. (Part-I) / %age of Total obtained Marks
X/Y x 100= Z
Z = ______
For Foreign Graduates: Z=80% of the aggregate score. No first attempt marks will be added to Foreign Graduates.
Ist Prof. (Part-II)
II Professional
III Professional
Final Professional
Grand Total / Total obtained Marks
X = / Total Marks
Y=
Marks Obtained out of 25
12. Particulars of the House Job:
Specialty Place From To Duration
Total duration of the House Job = Years ______Months______
Last Date of completion of House Job: ______
Duration between last date of House Job completion and the Joining date: (20-09-2016) = ______
13. Particulars of the Experience as after House Job.
Demonstrator/ MO/ RMO/ Dental Surgeon in the relative discipline
Specialty & Place Designation From To Duration
Page 3-3 (Deputation)
14. Experience of Government Service: Selectee of PPSC / Regularized
i. No. & Date of Ist Regular/ Offer Letter: (attach Certificate)
______
ii.No. & Date of the Ist Joining Letter: (attach Certificate)
______
iii.First place of posting: ______
iv.Present Place of posting ______
Total duration of Regular Govt. Service Experience ______Year _____ Months ______
15. Rural areaService (BHU, RHC & THQ) From ______To ______Duration: ______
Duration ______Year _____ Month______
(Experience Certificates must be issued by the Punjab Health Department/ District Government
along with First Appointment Orders and Joining letter).
16. Previous Deputation availed:
a.Course Name ______
b. Duration From ______To ______Duration ______
c. Institution / Place ______
DECLARATION
I hereby declare that the above particulars are correct in every respect, have not concealed anything and have not submitted any fake/ illegal document otherwise; my admission will be liable to be cancelled. I have appeared in the Entrance Examination and will appear for interview for admission in the course. I shall follow the rules and regulations regarding examinations and duration of course notified by UHS during the course of studies. I hereby agree/ understand that any reservation / objection regarding the merit list will not be entertained within three (03) days after display of the merit list.
Dated:______Signature of the Candidate: ______