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UNIVERSITY OF HEALTH SCIENCES LAHOREPrivate Sector Medical/Dental Institutions of PunjabFOR CANDIDATE OF BALOCHISTANApplication FormFor Admission to First Year MBBS/BDS Programme against one (01) seat reserved for candidates ofBalochistan in each Private Sector Medical & Dental Institutions of Punjab by PM&DCSession 2018-2019Agg. Percentage (As per PM&DC formula)Part 1 – Personal Information%1. Name of the Applicant2. Father’s/Guardian NamePaste Recent ColorPhotograph (3.5cm wide &4.5cm high) attested onthe front and attach threeattested on the back3. Mother’s Name4. Gender5. NationalityMF6. Date of Birth7. Province of Domicile/Local 8. District of Domicile/LocalBalochistanDDMMYYYY9. CNIC/B-Form No.10 Mailing Address (Res.) in Pakistan only11 Tel (Landline)12.Cell13. E-mailPart 2 – Qualifications (Matriculation and HSSC must be from ution AttendedBoard /UniversityYear quivalentthHSSC/12 Grade/EquivalentPart 3 – Provincial Admission Test(A)rdProvincial Admission Test for Balochistan held on 3 February, 2019Roll NumberMarksObtainedTotalMarksDated:Signature of Applicant
Part 4 – Declaration of PreferencesVERY IMPORTANT(1)When filling out the application, every applicant has to rank the medical and dentalcolleges/institutes in order of preference, starting with his/her first choice. In other words, all eligiblecandidates are allowed to list up all the private sector medical and dental colleges/institutes in theorder that they would like to be considered for admission.(2)The order of preferences once submitted shall be final and cannot be changedsubsequently. This condition is mandatory and neither any subsequent change isentertainable nor any exceptions will be made.(3)Starting with the first preference, applicants will be assessed and ranked according to the merit foreach college/institute. A computerized matching process will allocate applicants meeting theminimum merit requirements a place to the highest listed preference for which they are eligible.(4)Once offered a place to the highest listed preference, an applicant cannot demand admission to acollege/institute named lower in his/her preferred list.(5)An applicant, under no circumstances, shall be considered for a college/institute, he/she hasnot named in his/her order of preferences. The Admitting University shall not assign acollege/institute by itself if the alternate choices are not indicated.(6)The applicant must give the preference of medical and dental colleges in one list.ChoiceNo.Full Name of the InstitutionSignatures of gnature of Applicant2
ChoiceNo.Full Name of the InstitutionSignatures of re of Applicant3
Part 5 – Solemn Affirmation by the ApplicantIS/D/Osolemnly affirm that theinformation contained in this Application Form, and the documents attached with this form, are complete and accurate.I understand that if any information in this application, or in the documents and certificates that are attached with thisapplication, is not complete or accurate, I shall not be considered for admission, and if somehow admitted, the AdmittingUniversity shall cancel my admission, and I shall be expelled from the institution, and all fees and other dues paid by meto the institution up to that time shall be forfeited.I have gone through the Pakistan Medical and Dental Council (MBBS and BDS admissions, house job, internship)Regulations 2018 and I undertake to abide by all conditions.I understand that the choices for colleges/institutes given by me in this Application Form are final and no subsequentchange is permissible.I agree that submission of this Application Form does not confer any right on me in respect of selection for admission,which shall only be granted on merit.I understand that in case of failure to join the college or deposit fee by due date, my admission shall stand cancelledautomatically.Name of ApplicantSignatures of ApplicantDate:Thumb Impression(Left Thumb for Male and Right for Female)Part 6 – Declaration of the Father/GuardianI,Father/Guardian of Mr./Ms.an applicant for admission to a medical/dental institution of Punjab, fully understand that if any of the statements made inthe above application is found to be wrong in any way my son/ daughter would be liable to be refused admission to theinstitution even otherwise eligible and if admitted would be liable to expulsion from the institution at any time during thecourse of his/her studies and in such a case, all fees and other dues paid by him/her up to the time of expulsion shall beforfeited.I, also undertake to fulfill any other requirement in the shape of bond/affidavit required of me by the AdmittingAuthority/Institution.Name of Father / GuardianSignatures of Father / GuardianFather/Guardian CNIC No.For office use onlyReceived the Application Form of Mr/Ms, 2019 atam/pmon this day ofCenter.Name & Signature of the Dealing Officer4
CHECK LIST OF DOCUMENTS ATTACHEDPlease tick ( ) the relevant boxes Three (03) attested copies of Matriculation (SSC) Certificate or result card issuedby concerned BISE/Equivalence Certificate of O-Level, etc., issued by IBCC.Matriculation or Equivalent must be from Balochistan. Three (03) attested copies of HSSC Pre-Medical result card issued by concernedBISE /Equivalence Certificate of A-Level/12th Grade,etc. issued by IBCC. HSSCor Equivalent must be from Balochistan. Three(03) attested copies of transcripts of A-level/12th Grade, etc., (in case offoreign qualifications) issued by concerned foreign university/high school/board. Three (03) attested copies of result card of relevant Provincial Admission Test(MDCAT) conducted on 3rd February, 2019. Three (03) attested copies of Domicile Certificate Local/PRC of the candidatewhich must be Balochistan. Three (03) attested copies of CNIC/B-Form of the candidate. Three (03) attested copies of CNIC of Father / Guardian. Four (04) recent color photographs of the candidate, Size: 3.5cm wide & 4.5cmhigh (One to be pasted on the form and then attested on the front; other threeattested on the back and attached with the form). Original Undertaking on Rs.100/- stamp paper (as per template given asAnnexure P-1 on UHS website: www.uhs.edu.pk Three (03) attested copies of Hifz-e-Quran Certificate issued by a registeredMadrassa (only for candidates claiming to be Huffaz-e-Quran).Name & Signature of ApplicantName & Signature of the Dealing OfficerDate:5
LIST OF PRIVATE SECTOR MEDICAL & DENTAL INSTITUTIONS OF THE PUNJABPrivate Sector Medical Colleges Offering MBBS1.Akhtar Saeed Medical & Dental College, Lahore2.Al-Aleem Medical College, Lahore3.Amna Inayat Medical College, Sheikhupura4.Avicenna Medical College, Lahore5.Aziz Fatima Medical & Dental College, Faisalabad6.Azra Naheed Medical and Dental College Lahore7.Bakhtawar Amin Medical & Dental College, Multan8.Central Park Medical College, Lahore9.Continental Medical College Lahore10.FMH College of Medicine & Dentistry, Lahore11.Independent Medical College, Faisalabad12.Islam Medical College, Sialkot13.Lahore Medical & Dental College, Lahore14.M. Islam Medical & Dental College, Gujranwala15.Multan Medical & Dental College, Multan16.Pak Red Crescent Medical & Dental College, Lahore17.Rahbar Medical & Dental College, Lahore18.Rai Medical College, Sargodha19.Rashid Latif Medical College, Lahore20.Sahara Medical College, Narowal21.Shahida Islam Medical College, Lodhran22.Shalamar Medical & Dental College, Lahore23.Sharif Medical & Dental College, Lahore24.Sialkot Medical College, Sialkot25.University College of Medicine & Dentistry, Lahore26.University Medical & Dental College, FaisalabadPrivate Sector Dental Institutions Offering BDS1.Dental Section, Akhtar Saeed Medical & Dental College, Lahore2.Dental Section, Bakhtawar Amin Medical & Dental College, Multan3.Faryal Dental College, Sheikhupura4.Dental Section, FMH College of Medicine & Dentistry, Lahore5.Islam Dental College, Sialkot6.Dental Section, Lahore Medical & Dental College, Lahore7.Margalla Institute of Health Sciences, Rawalpindi8.Dental Section, Multan Medical & Dental College, Multan9.Dental Section, Sharif Medical & Dental College, Lahore10.University College of Medicine & Dentistry, Lahore11.Dental Section, University Medical & Dental College, Faisalabad12.Watim Dental College, Rawalpindi6
ANNEXURE-P1UNDERTAKING (Specimen)(To be submitted on Rs.100/- Stamp Paper)1.2.3.4.5.6.7.8.I Mr/MsS/D/Osolemnly declare that all the particulars mentioned in the Application Form are TRUE and CORRECT and I fullyunderstand that if any of the statements made in the application is found to be incorrect or any documentproduced with this form is found false/fake/fabricated, I would be liable to refusal for admission to themedical/dental institution, if otherwise eligible for admission and admitted, would be liable to be expelled fromthe institution at any time during the course of my studies in which case all fee and other dues paid by me to theinstitution shall be forfeited and shall be debarred from admission for a period of 7 years besides initiation of anyaction under law including criminal proceedings against me.I have gone through the Pakistan Medical and Dental Council (MBBS and BDS admissions, house job,internship) Regulations 2018 and I undertake to abide by all conditions.I also solemnly declare that, if admitted, I will abide by the discipline, rules, and regulations of the institution asenforced at present and made from time to time by the institution authorities in future. I will concern myself onlywith the academic activities and such extracurricular activities, which are allowed by the institution for thehealthy growth of body and mind. I undertake that I will not take part in any political activity or agitation and Iwill not become a member of any student wing of political, sectarian or caste-based parties of Pakistan. Inmatters of discipline, the decision of the head of the institution will be final and binding on me and I will notchallenge that decision in any court of law in the country. I will be regular in paying institution’s dues and willbe punctual in attending my classes. I will not absent myself from teaching programmes without prior permissionof the authority.I undertake that so long as I am a student of the institution, I will do nothing either inside or outside theinstitution, hostels and hospital premises that may interfere with its orderly administration and discipline or maybring the institution or its administration into disrepute.I understand that the choices for colleges/institutes submitted by me in this Application Form are final and nosubsequent change is permissible.I agree that submission of this Application Form does not confer any right on me in respect of selection foradmission, which shall only be granted on merit.I understand that in case of failure to join the college or deposit fee by due date, my admission shall standcancelled automatically.I solemnly declared that if admitted to a private medical / dental institutions, I shall submit a wealth statement ofeither parent/guardian equivalent to five years tuition fee, income tax return of either parent/guardian and shallalso submit insurance certificate to ensure the payment of fees for the remaining duration of the course in case ofdemise of parent/guardian.(Signatures of Father /Guardian)(Signatures of the Applicant)(Name of the Applicant)Father /Guardian Name:C.N.I.C No.:Thumb Impression(Left Thumb for Male and Right for Female)Dated Phone/Cell#7
26. University Medical & Dental College, Faisalabad Private Sector Dental Institutions Offering BDS 1. Dental Section, Akhtar Saeed Medical & Dental College, Lahore 2. Dental Section, Bakhtawar Amin Medical & Dental College, Multan 3. Faryal Dental College, Sheikhupura 4. Dental Section, FMH College of Medicine & Dentistry, Lahore 5.
