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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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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
