App Form Bba Ihm 20101208

APPLICATION FORM
FOR ADMISSION TO
BBA/BS in Social Sciences (SESSION 2011) at INSTITUTE OF HEALTH MANAGEMNET (IHM)
Application No. (AP No.)
DOW UNIVERSITY OF HEALTH SCIENCES, KARACHI

Fill the form in block letters.
Photograph
Name of Applicant Passport Number Birth Date National ID No. Or B Form No. Home Address
(Present) (for overseas candidates)
Fathers Name Nationality Birth Location Birth Country Marital Status Age on closing date Religion Tel No. Mobile:
Male
Female
Home Address
(as mentioned in NIC)
E-mail:
Address Out side Pakistan

(for overseas candidates)
EDUCATION AND ACADEMIC DEGREES

Academic Degree Matric / O-Level / Other
Intermediated/A- Level / Other
Major Subject School/University/City
Country
Duration
Result (% A-D)
Bachelor Master Other degree

If applicatble
PRACTICAL / PROFESSIONAL WORK EXPERIENCES (IF APPLICABLE)

Institution Position Held Duration From To
Courses/workshops attended (If applicable) S. No. Name Date
Language Skills (Please tick in the relevant box)

Language Fair Good Excellent
English Urdu Other
Computer Skills (Please tick in the relevant box)

Language None Fair Good Excellent
MS Word MS Power Point Internet Any Other Advance Skill
Reasons for selecting this course
APPLICANTS DECLARATION
I certify that the information in this application is accurate to the best of my knowledge. Furthermore I agree to inform to the admission cell, DUHS immediately of changes and amendments. I have taken note of the information provided in and regarding this application as well as the notice about the storage of personal data. I accept responsibility for the completeness of my application. I agree that this application and accompanying documents shall remain with the admission cell, Dow University of Health Sciences.
Place
Date
Signature
CERTIFICATE FROM PRINCIPAL OF INSTITUTE (LAST ATTENDED)

This is to certify that Mr. / Miss Mr. admitted into Name of Institute Address of Institute 1) Name of Students and Fathers Name 2) Present address class from Son / daughter of was a student of this college having been till
3) Permanent Address
4) Final year Graduate examination a. Date of Passing b. Division / Grade Institute Registration No. Total Marks Obtained / Maximum Marks
c. No. of attempts in which passed d. Whether received any warning or punishment during the time when he/she was student of the college, if so give details
It is further certified that during his/her period of stay in this college his/her work, conduct & character was
Place Date
SIGNATURE OF THE PRINCIPAL WITH SEAL
Particulars of Father/Mother/ Guardian
1. Name 2. Occupation 4. Place of work 5. Name of organization 6. Office Address 3. Designation
7. Present Residential Address
8. Permanent Address
9. Email address 10. Office Phone 11. Res. Phone 12. Any Other Contact Number 13. Annual Income 15. Nationality 16. NADRA NIC No.
(for Pakistani Candidate only)
Mobile Phone
14. Religion
NOTE: If father is working abroad. These particulars must be endorsed by Pakistan embassy / consulate of the respective country.
Signature of father
Fill all boxes with your present address
Name: Present Address
Phone No (Res.): Phone No (Off.): Mobile No. : Email:
Health Certificate
Note: (Section A, B, & C will be filled by the candidate)
Section A
Name Age Height: Present Address: Days Months S/o, D/o Years Weight:
Section B
1. Do you smoke? ................................................... 2. Do you take any medicine regularly? ....................... If yes, Specify 3. Any history of allergy .......................................... 4. Do you suffer from any of the following diseases? ........ i. Epilepsy ..................................................... ii. High Blood Pressure ...................................... iii. Psychiatric illness ....................................... iv. Rheumatic Heart Disease ............................... v. Hepatitis B/C .............................................. vi. Physical Disability ........................................ If yes, Specify Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No Yes Yes No No
Section C Details of previous Vaccination

1. Measles .................... 2. Mumps ..................... 3. Rubella .................... 4. Tetanus .................... 5. Pertussis ................... 6. Whooping Cough ......... 7. Hepatitis B ................ Yes Yes Yes Yes Yes Yes Yes No No No No No No No
Detail of Booster Vaccination
Certification: I hereby certify that the above information given by me is correct.
Signature Father / Mother
Signature
IMPORTANT INSTRUCTIONS FOR CANDIDATES

1. Candidates are advised to read the prospectus carefully for admission to the full time Graduate Program at at Institute of Health Management (IHM) of Dow University of Health Sciences for session 2011, before submitting the application form. 2. Fill all the columns of application form in BLOCK LETTERS with BLACK PEN. 3. Be sure to tick the appropriate Box in the application form.. 4. Photocopies of all required documents must be attested by Govt. officer, grade 18 and above. 5. Photocopy of the application form and incomplete form will be rejected. 6. No form will be accepted in any case after the last date and time of the application form. 7. Each application for admission should be accompanied by Non Refundable Entrance Test Fee of Rs. 1500/- (Rupees One thousand five hundred only) in the form of pay-order in the favour of Dow University of Health Science, (DUHS). 8. Carefully check the Required Documents list mentioned in the prospectus before submitting the application form. 9. Specimen of undertaking will be given when the candidate is declared eligible for provisional admission. 10. The application form and required documents completed in all respect should be submitted to United Bank Limited, Baba-e-Urdu Road, Branch, Karachi. Also please submit application form at our website. 11. If any eligible candidate has not received the admit card 48 hrs prior to the entrance test, he/she should contact DUHS help desk, mentioned in the Prospectus. 12. In case, their is any change in the date of Entrance test due to some unavoidable situation, it will be notified on the website of DUHS www.duhs.edu.pk 13. DO NOT submit the original documents alongwith the application form. 14. All queries should be sent on email address mentioned on the Back page. 15. No candidate should contact personally for any queries.
Note:
DO NOT attach this sheet or its photocopy with the application form.
Dow University of Health Sciences, Karachi.
ADMIT CARD
FOR ENTRY TEST
at Institute of Health Management (IHM) Session 2011
FOR ADMISSIONS in BBA/BS in Social Sciences
Name: Fathers Name: Postal Address: Tel No:

Signature of Candidate
Candidates Copy
Roll No.
Please Paste (1 x 1) Photograph
Mobile No:
Date:
Reporting Time:
E.mail:
For Official Use Name: Signature Seal
Left Hand Thumb Impression of Candidate
Venue:
Note: See Instructions Overleaf
Dow University of Health Sciences, Karachi.

ADMIT CARD
FOR ENTRY TEST
FOR ADMISSIONS in BBA / BS in Social Sciences Session 2011
at
Institute of Health Management (IHM) DUHS Copy Roll No.
Name: Fathers Name: Postal Address: Tel No: Mobile No:
Please Paste (1 x 1) Photograph
E.mail:
For Official Use Date:
Rep. Time:
Name: Signature Seal
Signature of Candidate
Left Hand Thumb Impression of Candidate
Venue:
INSTRUCTION FOR THE CANDIDATE

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. If there is any change regarding Entry Test, venue or timings, it will be mentioned on DUHS website. Carefully read instructions for attempting test paper, otherwise computer will not read your answers. Candidate must bring this Admit Card for the test, on the date, time and venue given overleaf. CANDIDATE WILL NOT BE ALLOWED TO APPEAR IN THE TEST WITHOUT THIS ADMIT CARD. No Identification other than this Admit Card will be acceptable. Impersonation for the Entrance test will be considered as a criminal case and will be dealt seriously. Candidate must report at 9:00 am sharp. Any material or electronic device / mobile phone / calculator etc, will not be allowed, under any circumstances. Candidate must bring Pencil of 2 1/2 HB, Rubber & Sharpener in a clear pouch. If any student is found, using unfair means or cheating he will be debarred from the test and admission. No candidate will be allowed inside the hall under any circumstances after the START of examination.

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APPLICATION FORM

Application No. (AP No.)

DOW UNIVERSITY OF HEALTH SCIENCES, KARACHI

Address Out side Pakistan

EDUCATION AND ACADEMIC DEGREES

Major Subject School/University/City

Bachelor Master Other degree

PRACTICAL / PROFESSIONAL WORK EXPERIENCES (IF APPLICABLE)

Courses/workshops attended (If applicable) S. No. Name Date

Language Skills (Please tick in the relevant box)

English Urdu Other

Computer Skills (Please tick in the relevant box)

MS Word MS Power Point Internet Any Other Advance Skill

Reasons for selecting this course

CERTIFICATE FROM PRINCIPAL OF INSTITUTE (LAST ATTENDED)

SIGNATURE OF THE PRINCIPAL WITH SEAL

Particulars of Father/Mother/ Guardian

1. Name 2. Occupation 4. Place of work 5. Name of organization 6. Office Address 3. Designation

7. Present Residential Address

Fill all boxes with your present address

Name: Present Address

Name: Present Address

Phone No (Res.): Phone No (Off.): Mobile No. : Email:

Phone No (Res.): Phone No (Off.): Mobile No. : Email:

Name: Present Address

Name: Present Address

Phone No (Res.): Phone No (Off.): Mobile No. : Email:

Phone No (Res.): Phone No (Off.): Mobile No. : Email:

Section C Details of previous Vaccination

Detail of Booster Vaccination

Certification: I hereby certify that the above information given by me is correct.

Signature Father / Mother

IMPORTANT INSTRUCTIONS FOR CANDIDATES

Dow University of Health Sciences, Karachi.

at Institute of Health Management (IHM) Session 2011

FOR ADMISSIONS in BBA/BS in Social Sciences

Name: Fathers Name: Postal Address: Tel No:

Left Hand Thumb Impression of Candidate

Dow University of Health Sciences, Karachi.

Institute of Health Management (IHM) DUHS Copy Roll No.

Name: Fathers Name: Postal Address: Tel No: Mobile No:

Please Paste (1 x 1) Photograph

Name: Signature Seal

Left Hand Thumb Impression of Candidate

INSTRUCTION FOR THE CANDIDATE

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