/ KHYBER MEDICAL UNIVERSITY
APPLICATION FORM FOR ADMISSION TO
1st YEAR BDS
KMU INSTITUTE OF DENTAL SCIENCES, KOHAT
SESSION 2017-18 /

Serial No: ______

(This form should be filled in BLOCK letters)

Note: Please read the instructions given in the admission policy and the prospectus before filling this form.

CATEGORY OF SEAT APPLYING FOR:

Note: Candidate applying for any of above catagories must tick the box. Unticked box will be considered crossed. The candidate can tick more than one box if he/she desires.

  1. Name: ______

(As per SSC (Science) or equivalent certificate in block letters)

  1. Date of Birth: ______/______/______3. Sex: ______
  1. District / Agency of Domicile: ______Date of Issue of Domicile: ______
  2. Father’s Name: ______
  3. Present Postal Address: ______
  4. Permanent Address: ______
  5. Phone No (s) Res: ______Cell: ______e-mail: ______
  6. Have you ever been admitted / studying in any Medical/Dental College in Pakistan. If Yes, mention name of the college:______
  7. Are you Hafiz-e-Quran Yes ☐ No ☐
  8. EDUCATIONAL QUALIFICATION:

Qualification / Year Passing / Annual / Supply / Roll No / Marks Obtained / Total Marks / Attempt (s) / Board / University
S.S.C (Science or equivalent
F.Sc (Pre-Medical) or Equivalent
  1. ETEA MEDICAL ENTRANCE TEST 2017

Entry Test ID ______Marks Obtained ______Percentage______

  1. Application Processing Fee: Rs.Bank Draft No: ______Bank Name: ______Dated:______

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FOR OFFICE USE ONLY:

Receipt No. Dated: Office Stamp: ______

REMARKS/DEFICIENCIES

ADJUSTMENT OF MARKS

Hafiz-e-Quran Marks / Deduction / SSC 10% Weightage / F.Sc 40% Weightage / Entry Test 50% Weightage / Merit Score

Checked by Member of Scrutiny Committee ______Chairman Scrutiny Committee ______

  1. Were you ever involved in criminal proceeding in a court of LAW? If Yes, attach brief account ______
  2. Name of School from where SSC Passed______
  3. Name of College from where F.Sc Passed ______

Signature of the Applicant’s Father/Guardian Signature of the Applicant

CNIC No: CNIC No or Registration No of Computerized Form B

- / - / - / -

IMPORTANT NOTES / INSTRUCTIONS

  1. Applications should reach the office of the Principal KMU-Institute of Medical Sciences, Kohat Development Authority (KDA), Kohat on or before the closing date and time. Applications received after the due date and time will not be entertained for admission.
  2. Original bank draft of Rs: 2,500/- as application processing fee shall be remitted in the name of Treasurer Khyber Medical University, Peshawar and must be attached with application form.
  3. Candidate not having domicile of KP are not eligible to apply for admission on Khyber Pakhtunkhwa seats.
  4. All applicants must appropriately fill and sign the admission form incomplete forms in any respect will not be accepted. Avoid overwriting / cutting while filling the form.
  5. Applicant must study the Admission Policy of KMU and the Prospectus in order to understand the Rules and Regulations regarding, admission procedure, distribution of seats, examination / tuition fees etc.
  6. Application forms with any false statement, the candidate will be rejected.
  7. The following documents must be attached with the application form in the following sequence.

The documents & certificates must be attested by Gazetted Officer. The stamp of the officer must bear full name, designation and current place of duty.

  1. 01 copy of Secondary School Certificate Examination (Science /equivalent).
  2. 02 copies of detailed Marks Certificate of examination on the basis of which admission is sought. (F.Sc or equivalent).
  3. An equivalence certificate from the Inter-Board Committee of Chairmen, Islamabad, if the qualifying certificate is from an Institute abroad.
  4. 01 copy of Computerised National Identity Card / Computerised Form-B of the candidate. (See instructions in the prospectus.
  5. 01 copy of computerized National Identity Card of the father of the applicant. (See above column-d) if the father is not alive, then a copy of the National Identity Card of the mother / guardian.
  6. 02 copies of the domicile certificate as mentioned in the entry test form.
  7. 01 copy of Domicile certificate of the father of the applicant. If the father is not alive, then the death certificate of the father issued by the municipal authority / hospital along with the domicile certificate of the mother showing clearly her spouse name, have to be submitted. In case the spouse name is not written in the mother’s domicile certificate then domicile certificate of the brother may be submitted. A guardianship certificate shall also be submitted in such cases [specimen of guardianship certificate is given at the end of prospectus].
  8. 03 passport size coloured photographs of the applicant with name, father name, and attestation on the back.
  9. 01 copy of Hafiz-e-Quran certificate if the candidate claims to be Hafiz-e-Quran.
  10. 01 copy of certificate of location of educational institute only by FATA-IN as per specimen in the prospectus.
  11. 01 copy of affidavit and undertaking regarding completion of study in KIMS as per specimen in the prospectus. Only for admitted students at the time of admission.

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