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Admission Form

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APPLICATION FOR M.Phil., M.Phil. LEADING TO Ph.D. & Ph.D.

AT
NATIONAL INSTITUTE FOR BIOTECHNOLOGY AND GENETIC ENGINEERING (NIBGE), FAISALABAD HAVING AFFILIATION WITH PAKISTAN INSTITUTE OF ENGINEERING AND APPLIED SCIENCES (PIEAS), ISLAMABAD.
Please read the instructions given in information Leaflet carefully before filling this form. USE ONLY BLOCK LETTERS 1. REGISTRATION NUMBER (TO BE ALLOTTED BY PIEAS) 2. PLEASE AFFIX A RECENT PHOTOGRAPH HERE

3. PERSONAL INFORMATION ABOUT THE APPLICANT Full Name Fathers Name Your name and fathers name as written above will appear in your degree and transcript. Any change to this information made later will cost Rs.1500/- per change E-mail Address Date of Birth Please provide the NADRA computerized NIC number CNIC Number Date - Month Year Sect means Sunni or Shia etc Religion means Islam, Christianity, Ahmedi or Buddhist etc. Sect Religion Marital Status Male/Female Domicile Nationality Permanent Address Postal Address Phone Number with City Code
4. DETAILS OF EDUCATIONAL QUALIFICATION OF THE CANDIDATE Certificate / Degree A B Matric / O level F.Sc. / A-level Name of the Institute/ Dept. where studied or still studying Name of the Board/University Year of Passing Subject/ Group Div./Grade/ CGPA Marks %

Mobile Phone Number

C D E F G H I J K L

B.Sc. / B.Sc. (Hons.) M.Sc. / BS (4 years) MBBS / DVM MS / M.Phil. Have You Studied Biology and Chemistry in F.Sc. / A Level? Please tick ( ) one Have You Studied Biology and/or Chemistry in B.Sc.? Please tick ( ) Have you taken the National Testing Service (NTS)? exam Please tick ( ) one: Have you taken the GRE subject Test exam ? Please tick ( ) one: Title of the final degree - -------------------------- e.g. M. Sc./ M. Sc. (Hons)/M..Phil. Yes Yes Yes Yes Declared Yes No Salary per Month Starting Date Ending Date No No No No If Yes then what is the score If Yes then what is the score

Result status of final degree examination Please tick ( ) one: 5. EMPLOYMENT RECORD (if any) Name of the Designation Govt. or department Private

If No then what is the expected Date of result declaration... Reason of Leaving

6. ADDITIONAL INFORMATION FOR MBBS CANDIDATES One Year of House job Completed? (Please tick one) Nature of House Job Starting Date (a) (b) -

Yes Ending Date

No

Date

Month

Year

Date

Month

Year

7. DETAILS OF APPLICATION PROCESSING FEE Application Processing Fee is Rs. 1000/- Application received without Application Processing Fee will not be entertained. The demand draft from any bank should be payable to NIBGE drawn on National Bank of Pakistan (AARI) Branch, Faisalabad (Bank Account 1060-1). Bank Draft/Pay Order No. Dated Name of the Bank with Branch/City

8. DECLARATION BY THE CANDIDATE I hereby affirm that the information given in this application is true and correct to the best of my knowledge and I understand that: 1. 2. Any wrong information by me will be sufficient cause for cancellation of this application or immediate dismissal later on even if I have been selected for admission to an M.Phil. / M. Phil. Leading to Ph. D. / Ph.D Biotechnology programme at NIBGE. If selected for admission I will abide by all the rules and regulations now in force or may become effective after I have joined. Signature of the Applicant: __________________________ Date: ___________________________

Tel: 041-9201804-09 Fax: 041-9201801 Web: www.nibge.org E-mail: director@nibge.org

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