College of Physicians & Surgeons Pakistan Form No: 2025-30319

7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606 Application Date: 11-02-2025
Website: www.cpsp.edu.pk

DNRP Online Application Form

Name: SANA ULLAH

Father's Name: JALANDER KHAN
Nationality: Pakistan
NIC No: 54301-7853529-1
Date of Birth: 04-10-1994
CPSP ID: 2023-6972 RTMC No: MED-2023-366-22235

Registration Information
Speciality: FCPS - MEDICINE
Country/State/City: Pakistan, Balochistan, Quetta
Institute: Mohtarma Shaheed Benazir Bhutto General Hospital, Quetta
Supervisor: CH MUHAMMAD ZUBAIR
Training Joining Date: 01-07-2023

Application Details
Category: Change of track
Valid Reason: Over time, I have developed a deep interest in the specialties offered within Group B, and I feel that this shift will not only
enhance my professional growth but also better align with my long-term career goals. Upon reflection, I have come to
realize that the expertise and skills gained from Group B are highly in demand and essential in my native village. There is
a growing need for professionals with these specific skills in the region, and I believe that transitioning to this track will
not only broaden my skill set but also provide me with an opportunity to contribute to the development of my community.
Moreover, the competencies developed in Group B are critical to addressing the unique challenges faced by my village,
and I am passionate about making a positive impact locally. I am confident that this track change will equip me with the
necessary tools to better serve both my career ambitions and the needs of my village. regards
Fee Information
Fee Type: Bank Challan Center: Quetta
Currency: PKR Amount: 2000
Receipt #: QTA-C-25-1061 Receipt Date: 11-02-2025
Bank Name: Meezan Bank Ltd. Branch Name: Tooba Masjid Branch

Following scanned original documents to be upload in step-2:

RTMC Certificate
Consent from CPSP Regional Director/Councilor CPSP
FCPS-I / IMM Congratulation Letter
Consent from Provincial Health Dept(if any)
Offer Letter / Provide proof of paid slot
Provide proof of approved e-log book entries
Joining Letter
Proof of synopsis/ article submission in REU /CPSP
Affidavit for extraining as penalty
Total Actual Duration of Residency Training

Supervisor and MS/Head of Institution (Leaving Institution):

____________________________________________________________

CPSP Regional Director / Councilor CPSP:

____________________________________________________________

Signature of Candidate:_______________________________________ Dated: 11-02-2025

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 ORIGINAL - Concerned Department DUPLICATE - Applicant

Branch: Tooba Masjid Branch Customer Code: CPSP Branch: Tooba Masjid Branch Customer Code: CPSP

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

DNRP Application DNRP Application

Cash Deposit Bank Challan Cash Deposit Bank Challan
Fee can be paid in any Meezan branch in Pakistan Fee can be paid in any Meezan branch in Pakistan
Via Utility Bill Collection Menu Via Utility Bill Collection Menu

Center: Quetta CPSP ID: 2023-6972 Center: Quetta CPSP ID: 2023-6972

Receipt #: QTA-C-25-1061 Receipt Date: 11-02-2025 Receipt #: QTA-C-25-1061 Receipt Date: 11-02-2025

Name: SANA ULLAH Name: SANA ULLAH

Form No: 2025-30319 Form No: 2025-30319

Fee Type Amount Fee Type Amount

DNRP Application Fee PKR 2000 DNRP Application Fee PKR 2000

Total: PKR 2000 Total: PKR 2000

Amount in words: Two Thousand Only (PKR) Amount in words: Two Thousand Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________

Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

Note: Depositer/candidate must ensure that bank stamp is readable and signed. Note: Depositer/candidate must ensure that bank stamp is readable and signed.
Note: The amount of fee applicable at the time of depositing the challan by the candidate will Note: The amount of fee applicable at the time of depositing the challan by the candidate will
be send to Meezan bank through API by CPSP. be send to Meezan bank through API by CPSP.

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 TRIPLICATE - CPSP Finance QUADRUPLICATE - Bank

Branch: Tooba Masjid Branch Customer Code: CPSP Branch: Tooba Masjid Branch Customer Code: CPSP

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

DNRP Application DNRP Application

Cash Deposit Bank Challan Cash Deposit Bank Challan
Fee can be paid in any Meezan branch in Pakistan Fee can be paid in any Meezan branch in Pakistan
Via Utility Bill Collection Menu Via Utility Bill Collection Menu

Center: Quetta CPSP ID: 2023-6972 Center: Quetta CPSP ID: 2023-6972

Receipt #: QTA-C-25-1061 Receipt Date: 11-02-2025 Receipt #: QTA-C-25-1061 Receipt Date: 11-02-2025

Name: SANA ULLAH Name: SANA ULLAH

Form No: 2025-30319 Form No: 2025-30319

Fee Type Amount Fee Type Amount

DNRP Application Fee PKR 2000 DNRP Application Fee PKR 2000

Total: PKR 2000 Total: PKR 2000

Amount in words: Two Thousand Only (PKR) Amount in words: Two Thousand Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________

Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

Note: Depositer/candidate must ensure that bank stamp is readable and signed. Note: Depositer/candidate must ensure that bank stamp is readable and signed.
Note: The amount of fee applicable at the time of depositing the challan by the candidate will Note: The amount of fee applicable at the time of depositing the challan by the candidate will
be send to Meezan bank through API by CPSP. be send to Meezan bank through API by CPSP.

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