UNIVERSITY OF THE PUNJAB

ADMISSION FORM FOR DOCTOR OF MEDICINE EXAMINATION (LATE COLLEGE)

Please read the instructions carefully. Fill in your own handwriting (with blue ballpoint, without cutting, overwriting and fluid)
all the relevant information, provided in this form and attach all the required documents. Incomplete form will be rejected.

Late College Annual/Supplementary, 20 Part:

1. Category:
(I & II)

2. Registration No.
(Punjab University) Gender :..........................
(Male/Female)

3. Name of Candidate
(Block Letters) Roll No:.............................
(For Office Use)

4. C.N.I.C. No. Paste Photograph

(Passport Size)

5. Father’s Name
(Block Letters) * Without attestation
* Light blue background

(Name and Father's Name

must be mentioned on the
6. Father’s C.N.I.C. No. back side of photographs)

7. Present Address
(For correspondence)

Permanent District

Nationality Religion Thumb Impression

Date of Birth
(As Per Matric Certificate)

8. Name of the Institute.....................................................................................................................................

9. Name of Centre (City)

(At which to appear) (This column must be filled)

10. Subjects in which to be examined :

1. The Principles and Practice of Medicine including Therapeutics.
2. Medical Pathology and Bacteriology
3. One of the special subjects : -
(a) Psychiatry (g) Dermatology
(b) Neurology (h) Advanced Pathology Bacteriology
(c) Tropical Diseases and Helminthology (i) Haematology
(d) Pediatrics (Diseases of Children) (j) Tuberculosis; or
(e) Advanced Physiology and Bio-Chemistry (k) Any other branch of medicine approved by
(f) Advanced Pharmacology and Therapeutics the Board of Studies in Medicine.
11. Fee Information :
Amount Bank Challan No. Date

Branch Name

12. Subject of Thesis ............................................................ approved vide letter No.............................

......................................................................................................... Dated..............................................
13. Date of acceptance if any ..................................................................................................................

14. Candidate whose Thesis was accepted Year ................................. Roll No................
but who failed in the examination should Paste Photograph
Subject of Thesis .......................................... (Passport Size)

15. Year of passing the Final Professional M.B.,B.S. Examination....................under Roll No................
* Attested from front
* Light blue background
Signature of the Candidate : Permanent Address
(Name and Father's Name
must be mentioned on the
back side of photographs)
(Permanent Address must be written, otherwise form will be rejected.)

I certify that applicant has fulfilled the requirements contemplated under the Regulations in force in the year of
20.........; That he is of good moral and professional character approved by the Medical Faculty; that he has signed this application
in my presence; that his correct; and that he has been permitted by the University to appear in the M.D. Examination vide
..............................

Contact Number:
(In case of Female Candidate, contact number of Father/Guardian can also be mentioned)

(Name of the Chairman/Director/Principal of the Department/Institute/College)

C.N.I.C. No.
Signature and Office Stamp
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INSTRUCTIONS
Candidate is directed to read and comply with instructions hereunder before filling the Admission Form.
1. The form must be filled in with BLUE ballpoint, don’t use ink pen.
2. Each Candidate (Male/Female) must paste two latest passport size photographs (with sky blue background) at the specified places
of the Admission Form.
3. Affix Photograph in correct orientation, because it will be scanned for Computerized System.
4. The Form (with fee paid challan) must reach the Punjab University Office within due date otherwise the form will be rejected.
5. Deposit the required amount of fee in any branch of Habib Bank Limited.
6. The Examination begins on the date/s as given in the date-sheet. Every Candidate must keep his/her National Identification Card with
him/her in the Examination Hall while taking the Examination.
7. The Admission Form will be entertained only if the attested photo-copies of Registration Card are previous Result Cards issued by the
Punjab University are attached with the Form.
8. The incomplete Admission Form shall be rejected, if correct Registered No. is not mentioned or if incomplete or incorrect entry is
made in the Form. The University shall not take any responsibility for the consequences.

9. Fee through Money orders, Postal orders & Cheques shall not be accepted.

I hereby declare that I have read the above instructions carefully and shall abide by them.

Date..................................... .............................................
(Signature of the Candidate)
 3
UNIVERSITY OF THE PUNJAB
FEE RECEIPT FORM FOR DOCTOR OF MEDICINE EXAMINATION (LATE COLLEGE)
Please read the instructions carefully. Fill in your own handwriting (with blue ballpoint, without cutting, overwriting and fluid)
all the relevant information, provided in this form and attach all the required documents. Incomplete form will be rejected.

1. Category: Late College Annual/Supplementary, 20 Part:

(I & II)

2. Registration No.
(Punjab University) Gender :..........................
(Male/Female)

3. Name of Candidate
(Block Letters) Roll No:.............................
(For Office Use)

4. C.N.I.C. No. Paste Photograph

(Passport Size)

5. Father’s Name
(Block Letters) * Without attestation
* Light blue background

(Name and Father's Name

must be mentioned on the
6. Father’s C.N.I.C. No. back side of photographs)

7. Present Address
(For correspondence)

Permanent District

Nationality Religion Thumb Impression

Date of Birth
(As Per Matric Certificate)

8. Name of the Institute.....................................................................................................................................

all on-line branches of HBL are authorized to collect Examination fee.

must be pasted on backside of this page.

9. Name of Centre (City)
(At which to appear) (This column must be filled)

10. Subjects in which to be examined

1. The Principles and Practice of Medicine including Therapeutics.
2. Medical Pathology and Bacteriology Original Bank Challan
3. One of the special subjects : -
(a) Psychiatry (g) Dermatology
(b) Neurology (h) Advanced Pathology Bacteriology
(c) Tropical Diseases and Helminthology (i) Haematology
(d) Pediatrics (Diseases of Children) (j) Tuberculosis; or
(e) Advanced Physiology and Bio-Chemistry (k) Any other branch of medicine approved by
(f) Advanced Pharmacology and the Board of Studies in Medicine.

11. Fee Information :

Amount Bank Challan No. Date

Branch Name

Signature of the Candidate : Permanent Address

(Permanent Address must be written, otherwise form will be rejected.)

(Name of the Chairman/Director/Principal of the Department/Institute/College)

C.N.I.C. No.
Signature and Office Stamp

TO BE FILLED IN BY THE CANDIDATE

Serial No. (for office use) Serial No. (for office use)

Name: Name:

Address : Address :

Serial No. (for office use) Serial No. (for office use)

Name: Name:

Address : Address :
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All On-line Habib Bank Limited Branches are authorized

to collect Examination fee.

PASTE ORIGINAL BANK CHALLAN HERE

FOR OFFICE USE

Actual Amount Due Amount Received Receipt Number Date Amount Still Due

Admission Fee Late Fee

Reference made by the office to the defaulter:

Letter Number Date

Reminder Number Date

IMPORTANT INSTRUCTIONS:
1. Candidate is instructed to fill in the Admission & Fee Receipt Forms carefully. Incomplete forms shall be rejected
and returned forthwith. The Forms will be considered to have reached the University Office when these are received
complete in all respects. In all other cases, double fee will be charged accordingly.

2. The fee is payable through the Habib Bank Ltd. (University Branch) Lahore, or the Habib Bank Ltd. Branch of the
home-town concerned in the case of Mofussil Candidates, only on the bank challan prescribed for the University.

3. Money Orders, Postal Orders and Cheques shall not be accepted.