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Online Application PDF File1

An application form submitted by Dr. Aneela Rehman for the FCPS-II major subject examination in Obstetrics and Gynaecology to be held in February 2015. She paid a fee of PKR 15050 via a bank challan deposited at the United Bank Ltd Sunset Boulevard branch in Karachi. The form contains her personal details, registration information, and examination history.

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96 views

Online Application PDF File1

An application form submitted by Dr. Aneela Rehman for the FCPS-II major subject examination in Obstetrics and Gynaecology to be held in February 2015. She paid a fee of PKR 15050 via a bank challan deposited at the United Bank Ltd Sunset Boulevard branch in Karachi. The form contains her personal details, registration information, and examination history.

Uploaded by

nav2ed
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

College of Physicians & Surgeons Pakistan

7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606
Website: www.cpsp.edu.pk

Term: 25-FEB-2015

Online Application Form For FCPS-II (MAJOR SUBJECTS)


Appearing In:

Theory

Fee Type:
Fee Submission City
Receipt #:
Bank Name:
Branch Name:

Bank Challan
Fee Amount:
Karachi
KHI-C-14-6959
Receipt Date:
UNITED BANK LTD
Sunset Boulevard Branch, Karachi (1620)

PKR 15050
28-10-2014

Profile Information
CPSP ID:
Medical Reg. No:
PMDC Issue/Exp. Date:

2010-3135
55836-S
03-06-2009 ---- 31-12-2018

Full Name:
Father's Name:

ANEELA REHMAN
ABDUL REHMAN

Nationality:
Identity Card No:
Date of Birth:
Email:
Gender / Marital Status:

Pakistan
42501-2966906-6
10-03-1984
[email protected]
Female / Single

Form No:

698-29237

Repeater
Karachi
OBSTETRICS AND
GYNAECOLOGY
OBG-2010-183-4634

Present/Mailing Address (Residential Only)


Address:
Tel (Res.):
Cell:

H/NO. H-8/3-4 STEEL TOWN


Karachi, Sindh, Pakistan
021-34157594
03312652689

Tel (Office):
Postal Code:

Permanent Address (Residential Only)


Same as Mailing Add:
Address:
Tel (Res.):
Cell:

Yes
H/NO. H-8/3-4 STEEL TOWN
Karachi, Sindh, Pakistan
021-34157594
03312652689

Tel (Office):
Postal Code:

Particulars of Last Examination Appeared


Roll Number:
Enrolment:

12103

Date of Examination:
Center:

27-08-2014
Karachi

Declaration
I do hereby declare that information given above is correct to the best of my knowledge. Incorrect information may lead to cancellation of enrollment /
admission / results and disciplinary action.

Signature of Candidate: ________________________________


Dated: 28-10-2014

Name: ANEELA REHMAN

Note:
For quick and effective communication all correspondence with the candidates will be done through email rather than by postal means / courier.
Overwriting is not allowed on the hard copy of the application form nor any candidate is allowed to change his/her particular electronically.
Once entered in the application the center will only be changed after submission of prescribed fee fo this change.
Candidates are advised to attach a hand written application if they want to change their particulars.
If you have any problem then contact at this number: 021-99207100 Ext. 246 or email at [email protected].

page 1 / 3

ORIGINAL

DUPLICATE

- Concerned Department

Branch: Sunset Boulevard Branch, Karachi (1620)

Account #: 100-4666-8

Branch: Sunset Boulevard Branch, Karachi (1620)

College of Physicians and Surgeons Pakistan

Karachi

Receipt #:

KHI-C-14-6959

Name:

ANEELA REHMAN

Account #: 100-4666-8

College of Physicians and Surgeons Pakistan

Bank Challan
Center:

- Applicant

Bank Challan
RTMC No: OBG-2010-183-4634
Receipt Date: 28-10-2014

Center:

Karachi

RTMC No: OBG-2010-183-4634

Receipt #:

KHI-C-14-6959

Name:

ANEELA REHMAN

Receipt Date: 28-10-2014

Form No: 698-29237

Fee Type
Exam Fee - FCPS-II

Total:
Amount in words: Fifteen Thousand and Fifty Only

____________________________
Candidate / Depositor Signature
Contact No: ________________

Form No: 698-29237

Session

Amount

FEB-2015

PKR 15050

Exam Fee - FCPS-II

PKR 15050

Total:

(PKR)

____________________________
Receiver's Signature

Fee Type

Session

Amount

FEB-2015

PKR 15050

PKR 15050

Amount in words: Fifteen Thousand and Fifty Only

____________________________
Candidate / Depositor Signature

(PKR)

____________________________
Receiver's Signature

Contact No: ________________

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TRIPLICATE

Branch: Sunset Boulevard Branch, Karachi (1620)

QUADRUPLICATE

- CPSP Finance

Account #: 100-4666-8

Branch: Sunset Boulevard Branch, Karachi (1620)

College of Physicians and Surgeons Pakistan

Karachi

Receipt #:

KHI-C-14-6959

Name:

ANEELA REHMAN

Account #: 100-4666-8

College of Physicians and Surgeons Pakistan

Bank Challan
Center:

Bank Challan
RTMC No: OBG-2010-183-4634
Receipt Date: 28-10-2014

Center:

Karachi

RTMC No: OBG-2010-183-4634

Receipt #:

KHI-C-14-6959

Name:

ANEELA REHMAN

Receipt Date: 28-10-2014

Form No: 698-29237

Fee Type
Exam Fee - FCPS-II

Total:
Amount in words: Fifteen Thousand and Fifty Only

____________________________
Candidate / Depositor Signature
Contact No: ________________

- Bank

Form No: 698-29237

Session

Amount

FEB-2015

PKR 15050

Exam Fee - FCPS-II

PKR 15050

Total:

(PKR)

____________________________
Receiver's Signature

Fee Type

Session

Amount

FEB-2015

PKR 15050

PKR 15050

Amount in words: Fifteen Thousand and Fifty Only

____________________________
Candidate / Depositor Signature

(PKR)

____________________________
Receiver's Signature

Contact No: ________________

page 3 / 3

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