federal postgraduate medical institute
shaikh zayed postgraduate medical institute
Form No
Course Session
Course Title
Fee
Personal Information form
Full Name
P.M.D.C No
Date of Birth
Place of Birth
Nationality
Nationality Id No
Father Name
Father Occupation
Spouse Name
Spouse Nationality
Marital Status
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Single
Married
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Children (Mention Name And Age)
Name
Address (Indicate Where you wish your correspondence to be send)
Permanent Address
Permanent Phone
Postal Address
Postal Phone
Domicile
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Punjab
Sindh - Urban
A.J Kashmir
Baluchistan
Sindh Rural
Curriculum leading to Degree / Diploma of
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D.A
D.C.H
D.C.P
D.G.O
D.L.O
D.M.R.D.I
D.M.R.T
D.O.M.S
D.T.C.D
D.M.J
M.D
M.S
M.Phil
F.C.P.S Part-II
Govt Service
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Federal
Autonomous
Province
Appointment
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Adhoc
Regular
Contract
Baluchistan
Sindh Rural
Public Service Commission
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Federal
Autonomous
Private Service
Academic Institution
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Yr / Less
2-5Yrs
5-10Yrs
10Yrs / Mors
Disciplinary Action
Disciplinary Action
Personal Interests,Hobies etc
Academic Qualification
M.B.B.M 1st Prof (Part I)
Roll No
Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
M.B.B.M 1st Prof (Part II)
Roll No
Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
M.B.B.M 2st Prof
Roll No
Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
M.B.B.M 3rt Prof
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Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
Final Prof
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Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
Other
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Year Qualified
Marks Aggregate
% Aggregate
Attempt
College
Academic Honours
Academic Honours
Position in University
Position in College
Distinction
Medals
Position in University
Position in College
Distinction
Medals
Research / Publication (Given Details Separately)
Names of Journals
Select Option
Select Option
Yes
No
Practical Experience
Experience (Medical Officer Registrar / Demonstrator
Total Duration (Y.M)
From Date
To Date
Subject
Institution
Name of Prof / Head of Department
Senior Registrar
Total Duration (Y.M)
From Date
To Date
Subject
Institution
Name of Prof / Head of Department
Any Other
Total Duration (Y.M)
From Date
To Date
Subject
Institution
Name of Prof / Head of Department