KHYBER MEDICAL UNIVERSITY APPLICATION FORM FOR ADMISSION Transitional BS Occupational Therapy (01 Year) Program SESSION FALL 2018 Serial No. _________ (The form should be filled in BLOCK letters) read the instructions given in the admission policy in the prospectus and on the Note: Please reverse of application form before filling this form. Applicant shall pay Rs. 2500/- in KMU Account No. 0977029551007356 (free online) in any branch of Muslim Commercial Bank (MCB) and attach the Original fee receipt at the time of submission of application form. Name: Father/Husband Name: (As per SSC or equivalent certificate in BLOCK letters) Date of Birth (dd/mm/yyyy): Gender: Male / Female Domicile: ______ CNIC No.: Nationality: Mailing Address: Contact No. (Tel: Res) Cell: Email: Permanent address: In case of emergency please contact: Name& Parentage: Address: Cell/Tel: Application Processing Fee: Amount: Rs. Receipt No. Dated: EDUCATIONAL RECORD: Annual Qualification Year of Exam. Total Obtained Name of / Supply / Marks (SSC & onward) passing Roll No Marks Marks Board / University Improved SSC EXPERIENCE: Experience will be considered valid, only if valid experience certificate is provided at the time of submission of application form. Attach additional Sheet if necessary. Duration Name of Designation Job Description Organization/Institution From To Page 01 of 02 Were you ever involved in criminal proceeding in a Court of Law? If Yes, attach brief account:
KHYBER MEDICAL UNIVERSITY APPLICATION FORM FOR ADMISSION Transitional BS Occupational Therapy (01 Year) Program SESSION FALL 2018 Serial No. _________ (The form should be filled in BLOCK letters) Note: Please read the instructions given in the admission policy in the prospectus and on the reverse of application form before filling this form. Applicant shall pay Rs. 2500/- in KMU Account No. 0977029551007356 (free online) in any branch of Muslim Commercial Bank (MCB) and attach the Original fee receipt at the time of submission of application form. Name: Father/Husband Name: (As per SSC or equivalent certificate in BLOCK letters) Date of Birth (dd/mm/yyyy): Gender: Male / Female Domicile: ______ CNIC No.: Nationality: Mailing Address: Contact No. (Tel: Res) Cell: Email: Permanent address: In case of emergency please contact: Name& Parentage: Address: Cell/Tel: Application Processing Fee: Amount: Rs. Receipt No. Dated: EDUCATIONAL RECORD: Qualification (SSC & onward) Year of passing Annual / Supply / Marks Improved Exam. Roll No Total Marks Obtained Marks Name of Board / University SSC EXPERIENCE: Experience will be considered valid, only if valid experience certificate is provided at the time of submission of application form. Attach additional Sheet if necessary. Name of Organization/Institution Duration Designation Job Description From To Page 01 of 02 Were you ever involved in criminal proceeding in a Court of Law? If Yes, attach brief account:
Admission%20Form%20TBSOT.Fall%2018%20%28A-4%29.docx