College of Physicians & Surgeons Pakistan Form No: 125-137398

Training Session: Jan-2025

7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606 Application Date: 14-02-2025
Website: www.cpsp.edu.pk

FCPS-II Training Registration Form

Full Name: MUHAMMAD ASLAM JAVID

Father's Name: MUHAMMAD SARFRAZ
Nationality: Pakistan
NIC No: 33106-6557826-1
Date of Birth: 04-05-1998
Gender/Marital Status: Male / Single
Email: [email protected] PMDC No: 760649-01-M

Registration Information
Program: 1st Fellowship
Speciality: SURGERY
Country/State/City: Pakistan, Punjab, Sahiwal
Institute: SAHIWAL MEDICAL COLLEGE/DHQ HOSPITAL
Supervisor: ZAHID SATTAR Unit/Department: 2
Joining Date: 13-02-2025
Training Option: Will move to sub-speciality after General Surgery rotation

Present/Mailing Address (Residential Only)

Address: CHAK NO 621 GB RAI MEDICAL STORE TEHSIL TANDLIANWALA
Country/State/City: Faisalabad, Punjab, Pakistan
Tel (Res.): 03001700621 Tel (Office): 03454766104
Cell: 03001700621 Postal Code:

Permanent Address (Residential Only)

Same as Mailing Add: Yes
Address: CHAK NO 621 GB RAI MEDICAL STORE TEHSIL TANDLIANWALA
Country/State/City: Faisalabad, Punjab, Pakistan
Tel (Res.): 03001700621 Tel (Office): 03454766104
Cell: 03001700621 Postal Code:

Basic Medical Qualification

Degree/Diploma: MBBS Passing Year: 2022
City/State/Country: Faisalabad, Punjab, Pakistan
Institute:

FCPS-I Information
Speciality: SURGERY AND ALLIED Roll No: 72036
Enrolment No: F-23-10489 Session Date:

Fee Information
Form Submission Center Lahore Transaction ID: a4d994c2-cd20-45fe-8a20-5f2956af1e8c
Receipt #: LHR-O-25-5676 Receipt Date: 14-02-2025

Note:

Overwriting is not allowed on the hard copy of the application form nor any candidate is allowed to change his/her particular electronically
otherwise form may be rejected.
This application is valid for 4 months only. If rejected/ unaccepted it has to be resubmitted with registration fees.

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 College of Physicians & Surgeons Pakistan Form No: 125-137398
Training Session: Jan-2025
7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606 Application Date: 14-02-2025
Website: www.cpsp.edu.pk

Supervisor's Consent

Name of Candidate: MUHAMMAD ASLAM JAVID

Institute & Dept.: SAHIWAL MEDICAL COLLEGE/DHQ HOSPITAL, 2

I am willing to supervise the above named FCPS-II trainee in the speciality of SURGERY. I declare that trainee is
not my close relative.

Name of head of institution/Dean PGMI: _______________________________

Signature and stamp of head of institution/Dean PGMI: _______________________________

Name of supervisor: _______________________________

Signature of supervisor with stamp and RTMC #: _________________________________________________

Note: Prof. M. Shoaib Shahfi, Vice President & RD, CPSP RC-Islamabad, has submitted a letter #F.1-2/CPSP-ID/Admin/21, dated 24th November, 2021
which is selfexplanatory and reproduced below.
"Must Show stipend amount in appointment letter instead of paid trainee, and strictly apply from Jan, 2022 RTMC Session."
Declaration
* The information given by me in this form is entirely correct. I am fully aware of the fact that in case a candidate gives wrong information on any
account, he/she is liable to punitive action by the CPSP, which may include cancellation of the registration and debarring from appearing in CPSP
RTMC for such period as may be specified by the CPSP.

* I undertake to keep the CPSP informed of the progress of training from time to time, as required. I also undertake to inform CPSP promptly in case of
transfer / change of supervisor, failing which the unregistered period of training is liable for cancellation besides imposing such penalty as may be
specified by CPSP.

* I declare that supervisor is not my close relative.

* I understand that in RTMC Registration any type of fee is not refundable.

Signature of Candidate: ________________________________ Dated: 14-02-2025

Original Documents to be upload in step-2:

Step1 complete application form duly signed by Supervisor, Head of Institute and yourself as an applicant.
Scan copy of Paid Challan/ Pay Order/ Demand Draft.
One recent colour photograph with clear identity and attested from front.
Valid PMDC registration certificate.
FCPS part 1 result / exemption letter.
Appointment / placement order issued by institution's administration department.
Letter of joining from the department.
MBBS/BDS degree.
If there is any change in particulars please attach your written application.
Details required.
No. of trainee registered with the proposed supervisor
No. of beds in the relevant unit
Faculty members in the unit, duly verified from the head of institute

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 ORIGINAL - Concerned Department DUPLICATE - Applicant

College of Physicians and Surgeons Pakistan College of Physicians and Surgeons Pakistan

RTMC RTMC
Debit/Credit Card Debit/Credit Card

Center: Lahore PMDC/En.No: F-23-10489 Center: Lahore PMDC/En.No: F-23-10489

Receipt #: LHR-O-25-5676 Date: 14-02-2025 Receipt #: LHR-O-25-5676 Date: 14-02-2025
Name: MUHAMMAD ASLAM JAVID Name: MUHAMMAD ASLAM JAVID
Trans ID: d994c2-cd20-45fe-8a2 Approval Code: 200024 Trans ID: d994c2-cd20-45fe-8a2 Approval Code: 200024

Form No: 125-137398 Form No: 125-137398

Fee Type Session Amount Fee Type Session Amount

Registration Fee - FCPS Trainees Jan-2025 PKR 5000.00/= Registration Fee - FCPS Trainees Jan-2025 PKR 5000.00/=

Bank Service Charges PKR 80.00/= Bank Service Charges PKR 80.00/=

Total: PKR 5080.00/= Total: PKR 5080.00/=

Amount in words: Five Thousand and Eigthy Only (PKR) Amount in words: Five Thousand and Eigthy Only (PKR)

Terms & Conditions: Terms & Conditions:

In case of any refund/charge back against cards transaction through internet payment In case of any refund/charge back against cards transaction through internet payment
gateway, the candidate should claim the refund/charge back from CPSP directly. gateway, the candidate should claim the refund/charge back from CPSP directly.

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