Registration Form (Diploma Programmes) Note: Please read the instructions given in the Admission Policy before filling this form. Diploma Courses Select Your Desire Course* Anesthesia Technology – 2 Years Cardiology Technology – 2 Years Health Technology – 2 Years Pathology Technology – 2 Years Radiology Technology – 2 Years Surgical Technology – 2 Years Applicant's Name:* Applicant's CNIC:* Applicant's Father Name:* Applicant's Father CNIC:* Date of Birth:* Gender:* Male Female Martial Status: Single Married Permanent Address:* Phone No: Cell No:* E-mail Incase of Emergency: Guardian Profession: Guardian Cell No: Do you have any experience in Medical Profession? Yes No If yes write Down the Details: In case of Emergency, Please Contact: Address: Name: Educational Background Matric Marks (Medical) Total Marks Do you want to avail hostel facility ? Yes No Were you ever convicted in criminal proceedings in a Court of Law? if yes, attach a brief account. Certified that the facts produced above are correct to the best of my knowledge and belief. Attach Scan file – Maximum file size 2mb Upload Passport size Photo – Maximum file size 2 mb Upload Declaration I Son/Daughter of do hereby solemnly declare that the particulars given above are correct, in case of any wrong information of facts, i shall be responsible for the consequences,I further undertake the abide by all the rules and regulations of the institute and shall accept all the decision made by the institute\’s administration. Undertaking Acceptance* Yes Submit Reset
