1. technology and computing
2. consumer electronics
3. telephones

KING EDWARD MEDICAL UNIVERSITY LAHORE
Nilagumbad, Anarkali, Lahore, Pakistan.
Ph. No: 9211145-54
Since 1860
POSTGRADUATE ADMISSION FORM (SESSION____________)
M. PHIL
MS
MDS Ph.D
For office use only
S. No: __________________
Reg. #: __________________
Dept: _________________
Instructions
1.
2.
3.
4.
Use CAPITAL letters and write your details exactly as they appear in your documents.
Incomplete application form will not be accepted.
Cutting / over writing is not allowed.
Candidates found to have made false or incorrect
Statements in the form are liable to expulsion.
Please affix 3
Photographs
attested from
backside. (4x4)
Proposed Programme of Study
Proposed Department
Field of Research interest
Research topic (if known)
Preferred Supervisor (if known)
Applicant’s Personal Information
1. Full Name (First, Middle, Last)
2. Father’s Name (First, Middle, Last)
3. Marital Status
4. CNIC No
Single
1.
5. Date of Birth (DD/MM/YYYY)
1. /
-
Married
/
6. Gender
i. Male
ii. Female
6. Spouse Name (if married), Profession
Page 1 of 8
7. Address:
i. Present
1.
2.
ii. Permanent.
3.
4.
8. Domicile
9. Mobile Number
10. Landline Number
11. E-Mail Address (Compulsory)
Educational Information
Institute/Board/ Passing Obtained
No. of
Subject
University
Year Marks/Total Attempts
Degree
Matric/
O-Levels
Grade/Division
With
Percentage
Intermediate/ A-Levels
MBBS/
BDS
B.Sc (Hon)
Vision Sciences
M.Phil/MS/MD/MDS/FCPS
or Equivalent Education.
Medal / Distinctions / Achievements (if any please specify)
_____________________________________________________________________
_____________________________________________________________________
Work Experience
Job Title
Name of Organization
Full/Part-Time
From
To
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Current Status of Service
(Public/Private)
_____________________________________________________________________
_____________________________________________________________________
Brief sketch of research work done so far if any including title of the project, name of supervisor
and institution. Use additional pages if required. The statements should not exceed 500 words.
NOTE
Attach separate Research Proposal with proposed Supervisor and Co-supervisor (if know) (for Ph.D
and M.Phil applicants only).
Have you ever joined any Department/Institute/Centre of KEMU previously; if yes, give details:
Fee Details
Amount Rs:______________Bank Challan No. /Pay Order No.:________________________
Date: _____________________________Banch:__________________________________________
Page 3 of 8
Reference
This section must be completed by your present or past teacher, employer or person who knows
you well, academically and socially.
How long have you known the applicant and in what capacity?
What is your opinion about the Applicant’s suitability for the course chosen?
Please tick appropriately
One
tick per row
Outstanding
Excellent
Very Good
Good
Average
Unknow
n
Intellectual/Academic ability
Ability to work hard
Perseverance
Leadership
Creativity
Concern for other
Any other information what you feel is relevant
Referee’s Name
Signature
Designation
Address
Date
As many potential candidates apply, selection is extremely difficult. Your comments will provide us
with important information in assessing this application.
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Declaration and Signature
I solemnly declare that:
 I have neither joined nor shall join any other Institute / Department / Centre / College
during the course of my studies at King Edward Medical University, Lahore.
 I am not suffering from any infectious disease.
 I understand that the University may vary or reverse any decision made on the basis of
incorrect or incomplete information which I have provided.
 I have read and understood the University’s cancellation and refund policy.
 I understand that the University may obtain official records from any educational institution
I have previously attended.
I, undertake to:
A) Abide by the Statutes, regulations (including the Code of Honour of Students, of University
Calendar 2007 * Vol. 1) and rules etc. framed by the University of the Department /
Institute/Centre/College from time to time and shall be liable to any penalty including
rustication/expulsion, in case of violation on my part.
B) I accept as a condition of my admission the authority of the University that a student can be
required to withdraw his name from the rolls, if in the opinion of the Vice-Chancellor
/Director/Chairman/Principal of the Department/Centre/College, his stay is not conducive to the
welfare, either of himself or others in the Department/Institute/Centre /College. Should I fail to
withdraw my name immediately after being called upon to do so, it may be struck off the rolls of
the Department/Institute/Centre/College without any
Further notice to me.
C) Not to “indulge in politics”, and in case, I violate this undertaking and “indulge in politics” after
my admission by the University, I shall be liable to expulsion without any notice under the order of
the Vice-Chancellor which order shall be final and can be questioned only before the Supreme
Court of Pakistan vide judgment/order of the Supreme Court of Pakistan dated 01 July 1992.
D) I accept as binding on me as long as I am a student, all rules and regulations in force at the time
of joining and which might be framed subsequently.
E) Show good behavior;
F) Devote whole-heartedly to my studies and maintain the dignity and prestige of the University
Both in and outside the Campuses;
G) Pay in time all dues and fine, if any;
H) I will notify the new address to Assistant Registrar, DPCC, if there is any change in my contact
Address/phone number.
I ) I undertake to take examination unconditionally notified by the University/Department/
Institute/Centre/College.
J) I have read the relevant rules and regulations concerning admission before signing this
application.
k) Any change in Rules & Regulation of the any Program along with any change in fee would be
applicable to all students and there
would be no discretion available to any student to tag it old or new scheme.
Signature of Applicant
Date:
/
/
Page 5 of 8
Check List
Answered all relevant fields.
 Original Pay Order/ Bank Chalan.
 Kindly ensure to provide correct E-Mail Address.
 Enclosed an NOC from current employer (No Objection Certificate).
 Enclosed experience certificate from employer.
 Enclosed attested copies of:
 Matriculation
 Intermediate
 DMCs of all MBBS/BDS professional examinations.
 Degree of MBBS/BDS
 Attempt Certificate of MBBS/BDS
 House Job Certificate (One Year)
 M.Phil/MD/ MS/ MDS/ FCPS or Equivalent Education (DMCs & Degree).
 GAT (NTS) General/GRE ETS General or GAT Subject Based/GRE Subject Based
(Where Applicable).
 DMCs of BSC (Hon) Vision Sciences result (Where Applicable).
 CNIC
 Domicile certificate.
 Three photographs in blue background.
 Valid PM&DC Registration (Where Applicable)
 Copy of detailed resume.
 Copy of Publication (Where Applicable).
_____________________________________________________________________
OFFICE USE ONLY
Evaluation of Record
Academic Qualification
Matric + Inter
1st Professional
Admitted
Yes
No
2nd Professional
3rd Professional
Final Professional
House Job
Experience
Director/Chairman/Chairperson/Principa
l
Written Test
Interview
Publication
GAT (NTS)/GRE ETC (General) or
GRE/NTS Subject Based (Where
Applicable/Available)
Chairperson DPCC /
Coordinator of M.Phil
Program
Remarks:
Page 6 of 8
PLEASE NOTE: STUDENT MUST FILL BELOW ADDRESS BARS
Name__________________________________________________________________
Name______________________________________________________________
Father Name____________________________________________________________
Father Name________________________________________________________
Address________________________________________
____________________________________________
____________________________________________
Address___________________________________________
_______________________________________________
_______________________________________________
Mob. No.___________________________________________________
Mob. No.___________________________________________________
Landline No.________________________________________________
Landline No.________________________________________________
Name______________________________________________________
Name______________________________________________________
Father Name______________________________________________________
Father Name______________________________________________________
Address______________________________________
Address______________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Mob. No.___________________________________________________
Mob. No.___________________________________________________
Landline No.________________________________________________
Landline No.________________________________________________
Name____________________________________________________________
Name______________________________________________________
Father Name______________________________________________________
Father Name______________________________________________________
Address______________________________________
Address______________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Mob. No.___________________________________________________
Mob. No.___________________________________________________
Landline No.________________________________________________
Landline No.________________________________________________
_
Page 7 of 8
Specialty: _______________
ORIGINAL
For Office Use
(Entry Test Centre)
ADMIT CARD
University Based Subject Test
King Edward Medical University
Patiala Block, Lahore
POSTGRADUATE ADMISSION TEST
M. PHIL
MS
MDS Ph.D
Venue:
Dated:
Paste Recent
Photograph
(ID card size)
Time:
Name: Mr./Miss/Mrs.:
Father’s Name:
CNIC /Passport No:
Mobile:
Office Of Controller OF Examinations
NOTE :



Bring original CNIC/ PASSPORT.
Bring your own stationary; exchange of stationary is strictly prohibited.
Candidate must reach in the examination hall at least 30 minutes before
the start of examination.
Signatures of the Candidate_______________________
…………………………………………………………………………………………………………………………………
Specialty: _______________
DUPLICATE
For Candidate
M. PHIL
(Entry Test Centre)
ADMIT CARD
University Based Subject Test
King Edward Medical University
Patiala Block, Lahore
POSTGRADUATE ADMISSION TEST
MS
DS Ph.D
Venue:
Dated:
Time:
Name: Mr. /Miss/Mrs.:
Paste Recent
Photograph
(ID card size)
Father’s Name:
CNIC /Passport No:
Mobile:
NOTE :



Office Of Controller OF Examinations
Bring original CNIC/ PASSPORT.
Bring your own stationary; exchange of stationary is strictly prohibited.
Candidate must reach in the examination hall at least 30 minutes before
the start of examination.
Signatures of the Candidate_______________________
Page 8 of 8