General Nursing Admission Form
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Transcript of General Nursing Admission Form
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8/2/2019 General Nursing Admission Form
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APPLICATION FORM IN GENERAL NURSING, TRAINING ATS.O.N. FEDERAL GOVERNMENT POLYCLINIC (PGMI)
ISLAMABAD
Full Name_TABINDA GHAFOOR CHUGHTAI__ Name of Father _ABDUL GHAFOOR GHUGHTAI
Date of Birth 08.10.1993 Age: 17 Years 10 Months Place of Birth ISLAMABAD_
Domicile PUNJAB_(GUJRANWALA) Religion __ISLAM__ Nationality __PAKISTANI___
National Identity Card # ______N.A._______ Marital Status:- _____Unmarried_________
Temporary Address_3/1-E, St. 49, F-6/4, ISLAMABAD Telephone #_051-9215095, 0333-5199480
Permanent Address Village & P/O Kotjaffar, Tehsil Wazirabad, District Gujranwala.____
_____________________________________________Telephone # _________________________
ACADEMIC QUALIFICATIONS. # Examination
PassedYear Grade /
DivisionSchool/College / Board /University
01 Matriculation 2010 518/1050 D
2nd
Div.Federal Board of Intermediate &Secondary Education,Islamabad.
02 F.A . Part-I 2011 Result awaited Federal Board of Intermediate &Secondary Education,Islamabad.
05 Any otherHifz-ul-Quran 2007 85/100 A+ Dar-ul-Aloom Mahmoodia Tehfeez-ul- Quran, G-10/2, Islamabad.
Marks obtained in Science Subjects Physics 61 Chemistry 63 Biology 78
Name and address of hospital/Institute, if worked previously? NO
I hereby solemnly declare that:-The information given above in the admission form is true/correct to the best of my knowledge
and belief. I have no objection if my daughter joins the Nursing Training in this School.
Signature of Parents _____________________Date:- ___12.08.2011____ Signature of Candidate ) _______________
MAILING ADDRESS 3/1-E, St. 49, F-6/4, ISLAMABAD_ Telephone # 051-9215095, 0333-5199480
NAME OF PERSON TO BE NOTIFIED IN EMERGENCY
NAME ABDUL GHAFOOR CHUGHTAI_ Relationship__FATHER___
Address _3/1-E, St. 49, F-6/4, ISLAMABAD_ Telephone #_051-9215095 , 0333-5199480
Attached Attested Photo Copies of:-a. Form B NADRAb. Domicile Certificate of Fatherc. Character/Provisional Certificated. Matriculation & Hifz-ul-Quran certificates.e. National Identity Card of Father.
_________________________________________________________________________________
RECEIPTReceived form No. ________020__________ from Miss TABINDA GHAFOOR CHUGHTAIFor ______General Nursing Training__________
Signature/Stamp ___________________
Space for latest
Photograph
Application Form #. __020___
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APPLICATION FORMSCHOOL OF NURSING
PAKISTAN INSTITUTE OF MEDICAL SCIENCESISLAMABAD
Full Name_TABINDA GHAFOOR CHUGHTAI_ Name of Father _ABDUL GHAFOOR GHUGHTAI
Date of Birth 08.10.1993 Place of Birth ISLAMABAD_ Domicile PUNJAB_(GUJRANWALA)
Religion __ISLAM__ Nationality __PAKISTANI___ National Identity Card # ______N.A.______
Marital Status:- _____________Single _______________
Present Address_3/1-E, St. 49, F-6/4, ISLAMABAD Telephone #_051-9215095, 0333-5199480
Permanent Address Village & P/O Kotjaffar, Tehsil Wazirabad, District Gujranwala.____
_____________________________________________Telephone # _________________________
ACADEMIC QUALIFICATIONS. # Examination
PassedYear Grade /
DivisionSchool/College / Board /University
01 Matriculation 2010 518 Marks D Federal Board of Intermediate &Secondary Education,Islamabad.
02 F.A . Part-I 2011 Result awaited Federal Board of Intermediate &Secondary Education,Islamabad.
05 Any otherHifz-ul-Quran
2007 85/100 A+ Dar-ul-Aloom Mahmoodia Tehfeez-ul- Quran, G-10/2, Islamabad.
NAME OF PERSON TO BE NOTIFIED IN EMERGENCY
NAME ABDUL GHAFOOR CHUGHTAI_ Relationship__FATHER___
Address _3/1-E, St. 49, F-6/4, ISLAMABAD_ Telephone #_051-9215095 , 0333-5199480
Have you attended any other School of Nursing? NOIf yes attach leaving Certificate.
Attached Attested Photo Copies of:-a. Form B NADRAb. Domicile Certificate of Fatherc. Character/Provisional Certificate
d. Matriculation & Hifz-ul-Quran certificates.e. National Identity Card of Father.
_________________________________________________________________________________
RECEIPTReceived form No. ________240__________ from Miss TABINDA GHAFOOR CHUGHTAIFor ______General Nursing Training__________
Signature/Stamp ___________________
Space for latest
Photograph
Application Form #. __240___
PLEASE READ ENTIRE FORM CAREFULLY
THE FORM MUST BE COMPLETED IN TYPE OR PRINT IN BLOCK LETTERS
INCOMPLETE APPLICATION FORM SHALL NOT BE ENTERTAINED
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8/2/2019 General Nursing Admission Form
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DECLARATION
I hereby solemnly declare that:-
The information given in the admission form is correct to the best of my knowledge and beliefand if any thin is found in correct; the School of Nursings Administration will have the right to cancelmy admission.
Date:- ___12.08.2011____ Signature of Candidate ________________________
Signature of Parents _____________________
MAILING ADDRESS3/1-E, St. 49, F-6/4,ISLAMABADTelephone # Res. 051-9215095
Cell. 0333-5199480Off. 051-9209449