Sie sind auf Seite 1von 3
Form No: 2018-29731 Workshop Registration Form Application Date: 16-07-2018 Full Name: MADIHA SULTAN Father's
Form No: 2018-29731 Workshop Registration Form Application Date: 16-07-2018 Full Name: MADIHA SULTAN Father's
Form No: 2018-29731
Workshop Registration Form
Application Date: 16-07-2018
Full Name:
MADIHA SULTAN
Father's Name:
SULTAN ALAM
New NIC:
61101-4012314-4
Date of Birth:
1986-03-12
Gender/Marital Status:
Female / Married
Email:
mmsultann5@gmail.com
Qualification Type:
MBBS
Registration Information
Program:
MCPS
Speciality:
FAMILY MEDICINE
Country/State/City:
,
,
Institute:
Supervisor:
Unit/Department:
RTMC #:
FMD-2018-000-3489
CPSP ID:
0000-3547

Workshop(s) Details

#

Workshop Name

Center

1

Introduction to Computer & Internet

LAHORE

Present/Mailing Address (Residential Only)

 

Address:

HOUSE NO 254, STREET 21 ,I-9/1

Country/State/City:

Islamabad, Punjab, Pakistan

Tel (Res.):

03365561754

Tel (Office):

 

Cell:

0336-5561754

Postal Code:

 

Permanent Address (Residential Only)

 

Address:

HOUSE NO 254, STREET 21 ,I-9/1

Country/State/City:

Islamabad, Punjab, Pakistan

Tel (Res.):

03365561754

Tel (Office):

 

Cell:

0336-5561754

Postal Code:

 

Fee Information

Fee Type:

Bank Challan

Fee Submission City:

Islamabad

Currency:

PKR

Amount:

2000

Receipt #:

ISL-C-18-6422

Receipt Date:

16-07-2018

Bank Name:

UNITED BANK LTD

Branch Name:

G-8, Al Markaz Branch, Islamabad (0234)

 

Declaration

Above is correct to the best of my knowledge. Incorrect information may lead to cancelation of enrollment / admission / results and disciplinary action.

Disclosure Information

The activity does not have any commercial support, and its organizers, planners and speakers do not have any relevant financial relationship.

Signature of Candidate:

Dated: 16-07-2018

Overwriting or electronic change is not allowed on the hard copy of this application form otherwise form may be rejected.Candidates are advised to attach a hand written application if they want to change their

Candidates are advised to attach a hand written application if they want to change their particulars.Overwriting or electronic change is not allowed on the hard copy of this application form otherwise

ORIGINAL

- Concerned Department

ORIGINAL - Concerned Department Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of

Branch: G-8, Al Markaz Branch, Islamabad (0234)

Account #: 010-2220-2

Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of Physicians and Surgeons Pakistan DME Bank

College of Physicians and Surgeons Pakistan

DME

Bank Challan

Fee should be deposited in above mentioned branch. Challan not to be used for Online Fee Transfer.

DUPLICATE

- Applicant

to be used for Online Fee Transfer. DUPLICATE - Applicant Branch: G-8, Al Markaz Branch, Islamabad

Branch: G-8, Al Markaz Branch, Islamabad (0234)

Account #: 010-2220-2

Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of Physicians and Surgeons Pakistan DME Bank

College of Physicians and Surgeons Pakistan

DME

Bank Challan

Fee should be deposited in above mentioned branch. Challan not to be used for Online Fee Transfer.

Center:

Islamabad

CPSP ID:

0000-3547

Center:

Islamabad

CPSP ID:

0000-3547

Receipt #:

ISL-C-18-6422

Receipt Date:

16-07-2018

Receipt #:

ISL-C-18-6422

Receipt Date:

16-07-2018

Name:

MADIHA SULTAN

Name:

MADIHA SULTAN

 

Form No: 2018-29731

Form No: 2018-29731

Fee Type

Amount

Fee Type

Amount

W/S Fees - I.T. Workshop

PKR

2000.00

W/S Fees - I.T. Workshop

PKR

2000.00

Total:

PKR

2000.00

Total:

PKR

2000.00

Amount in words: Two Thousand Only

(PKR)

Amount in words: Two Thousand Only

(PKR)

Candidate / Depositor Signature

Contact No:

Receiver's Signature

Candidate / Depositor Signature

Contact No:

Receiver's Signature

TRIPLICATE

- CPSP Finance

TRIPLICATE - CPSP Finance Branch: G-8, Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of

Branch: G-8, Al Markaz Branch, Islamabad (0234)

Account #: 010-2220-2

Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of Physicians and Surgeons Pakistan DME Bank

College of Physicians and Surgeons Pakistan

DME

Bank Challan

Fee should be deposited in above mentioned branch. Challan not to be used for Online Fee Transfer.

QUADRUPLICATE

- Bank

not to be used for Online Fee Transfer. QUADRUPLICATE - Bank Branch: G-8, Al Markaz Branch,

Branch: G-8, Al Markaz Branch, Islamabad (0234)

Account #: 010-2220-2

Al Markaz Branch, Islamabad (0234) Account #: 010-2220-2 College of Physicians and Surgeons Pakistan DME Bank

College of Physicians and Surgeons Pakistan

DME

Bank Challan

Fee should be deposited in above mentioned branch. Challan not to be used for Online Fee Transfer.

Center:

Islamabad

CPSP ID:

0000-3547

Center:

Islamabad

CPSP ID:

0000-3547

Receipt #:

ISL-C-18-6422

Receipt Date:

16-07-2018

Receipt #:

ISL-C-18-6422

Receipt Date:

16-07-2018

Name:

MADIHA SULTAN

Name:

MADIHA SULTAN

Name: MADIHA SULTAN Name: MADIHA SULTAN Form No: 2018-29731 Form No: 2018-29731 Fee Type Amount

Form No: 2018-29731

MADIHA SULTAN Name: MADIHA SULTAN Form No: 2018-29731 Form No: 2018-29731 Fee Type Amount Fee Type

Form No: 2018-29731

Fee Type

Amount

Fee Type

Amount

W/S Fees - I.T. Workshop

PKR

2000.00

W/S Fees - I.T. Workshop

PKR

2000.00

Total:

PKR

2000.00

Total:

PKR

2000.00

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: