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Application Number: Fa-2019-UG-29497

Sir Syed CASE Institute of Technology

Block A, Multi Garden, Sector B-17, Islamabad
Telephone: 92-51-5203471
Email: info@case.edu.pk Web: http://www.case.edu.pk/
Admission Application
Instructions: Fill the complete form in BLOCK LETTERS or type in BLOCK LETTERS
and Mail or hand-deliver this application form in along with all the required documents and
proof of submission of processing fee. Affix one
passport size
Have you ever taken a course at CASE: No. Yes Roll No: _____________________ photo here.
Semester Session: Spring Summer Fall 19
20____
Applied Degree: BSCS NTS Roll #: Score:
Priority Option 1: B. Sc. EE Priority Option 2: BSSE

Fee Paid: 2500.00

Applicant’s Personal Information

1. Name: MOEEZ AHMED

(as per your SSC / O-Level certificate)

2. Father’s Name: MUHAMMAD YOUNUS

(as per your SSC / O-Level certificate)

3. C.N.I.C./Form B No. 3110225852135

4. Date of Birth: 01/26/2001 5. Gender: Male Female

(as per your SSC / O-Level certificate)

6. Mailing Address: FLAT#5, BLOCK#26-E, AGPR COLONY, G-9/2, ISLAMABAD, ISLAMABAD, PAKISTAN.

7. Permanent Address: DAK KHANA, CHAK# 170 MURAD, CHAK#138 MURAD, TESHIL CHISTIAN, DISTRICT BHAWA

LNAGAR, ISLAMABAD, PAKISTAN.

8. Home Phone Number: 051-2324575 9. Applicant’s Mobile : 0304-5407031

10. E-Mail: M.MOEEZ898@GMAIL.COM

11. Academic Record

Degree / Certificate Institution
Subjects Year %
(Tick appropriate one) (Name, City & Country)
S.S.C
O-Levels IMCB G-10/4 ISLAMABAD BIOLOGY 2016 86.19
Others
H.S.S.C – I
H.S.S.C – II IMCB G-10/4 ISLAMABAD PRE-ENGINEERING 2018 83.27
A – Levels
Others
* For admission in B.Sc. Electrical Engineering, the applicant must have qualified Physics, Chemistry & Mathematics at
HSSC or equivalent level.

For office use only

Date: ____________________ Receipt No: __________

This is to acknowledge that the completed application form with all the required documents, listed on page 2, for Mr. / Ms.
____________________________has been received along with processing fee for admission in _________________
program. Received By ______________

Online Data Processing Date & Time: Wednesday, 17 July 2019 : 11:27:25
 Application Number: Fa-2019-UG-29497
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Parent’s / Guardian Information Parent Guardian
12. Parent’s / Guardian’s Name: MUHAMMAD YOUNUS (PARENT)

13. Parent’s / Guardian’ s CNIC Number: 31102-8582991-9

14. Employer: AGPR

15. Work Address: AIWAN-E-SANAT-O-TIJARAT, G-8 MAUVE AREA G-8/4, ISLAMABAD

16. Home Phone Number: 051-2324575 17. Mobile Number : 03335523050

18. Work Phone Number: 03335523050 19. Fax Number :

20. E-Mail (if any): IUBIANS138@GMAIL.COM

The Sir Syed CASE Institute of Technology (SS-CASE-IT) is committed to maintaining a safe environment and provision of
educational services. We require you to understand the terms and conditions of being a part of the educational program at
SS-CASE-IT. Please read carefully the following statement and sign:

21. UNDERTAKING
I understand that withholding pertinent information requested on this application or giving false
information will make me ineligible for admission to the SS-CASE-IT Degree Programs and will make
me subject to dismissal. With this in mind, I certify that the statements made in this application form and
documents accompanying my application form are correct and complete. I agree that if I am admitted to
SS-CASE-IT I will adhere to and be bound by the rules, regulations, and policies of SS-CASE-IT as laid
down now and modified subsequently.

Date: __________________________________ Applicant Signature:

Date: __________________________________ Father/Guardian Signature:

Instructions for form submission

Please make sure that you have read and understood the instructions for admission to the SS-CASE-IT academic programs. Please 5
tick the following as you ensure that all the required documents are enclosed.
Documents Required:
Completed application form in Duplicate.
Two attested copies of National Identification Card / Form B.
Two attested copies each of transcripts/academic records and degrees (SSC,HSSC, or equivalent).
In case of certificates other than S.S.C / H.S.S.C, attach equivalence certificate issued by Chairman Board Committee.
Four passport-size photographs.
Receipt for payment of Online Application Processing Fee: Rs. 2500/-
Two Attested copies of NAT Result Card if Already Qualified.
Note:
• The non-refundable application-processing fee of Rs. 2500/- can be
deposited in SS-CASE-IT Accounts Office. Alternatively, the applicant can send a Demand Draft/Pay Order payable
to CASE. Personal cheques are not acceptable.
• The completed application form and proof of submission of processing fee must be mailed or hand delivered to:
SS-CASE-IT, Block A, Multi Garden, Sector B-17, Islamabad during office hours of 08:00 AM till 04:00
PM, with in due date, Monday through Friday.
• Information about academic programs, application deadlines and academic calendar can be found at
http://www.case.edu.pk
• For further information contact:
Telephone: 051-5203473 E-mail: itabassam@case.edu.pk

Online Data Processing Date & Time: Wednesday, 17 July 2019 : 11:27:25
 Expiray Date: Sunday, 04 August 2019 Expiray Date: Sunday, 04 August 2019 Expiray Date: Sunday, 04 August 2019
Created with PDF4NET 2.7 evaluation version
Center for Advanced Studies in Engineering Center for Advanced Studies in Engineering Center for Advanced Studies in Engineering
Block A, Multi Garden, Sector B-17, Islamabad Block A, Multi Garden, Sector B-17, Islamabad Block A, Multi Garden, Sector B-17, Islamabad

Challan No: Fa19/00466 Challan No: Fa19/00466 Challan No: Fa19/00466

Issue Date: 07/17/2019 Issue Date: 07/17/2019 Issue Date: 07/17/2019
Due Date: 08/04/2019 Due Date: 08/04/2019 Due Date: 08/04/2019
73223 73223 73223
Name: Moeez Ahmed Name: Moeez Ahmed Name: Moeez Ahmed

Application ID/Roll No: Fa-2019-UG-29497 Application ID/Roll No: Fa-2019-UG-29497 Application ID/Roll No: Fa-2019-UG-29497

Semester: FA-2019 Degree: BSCS Semester: FA-2019 Degree: BSCS Semester: FA-2019 Degree: BSCS

# Particulars Amount Payable # Particulars Amount Payable # Particulars Amount Payable

1 Prospectus Fee 1500.00 1 Prospectus Fee 1500.00 1 Prospectus Fee 1500.00
2 Application Processing Fee 1000.00 2 Application Processing Fee 1000.00 2 Application Processing Fee 1000.00

Gross Amount Payable 2500.00 Gross Amount Payable 2500.00 Gross Amount Payable 2500.00
Less: Scholarship (If any) 0.00 Less: Scholarship (If any) 0.00 Less: Scholarship (If any) 0.00
Less: Amount Already Paid 0.00 Less: Amount Already Paid 0.00 Less: Amount Already Paid 0.00

Less: Amount Paid Now 2500.00 Less: Amount Paid Now 2500.00 Less: Amount Paid Now 2500.00
Balance Payable 0.00 Balance Payable 0.00 Balance Payable 0.00

Total Amount to be Paid 2500.00 Total Amount to be Paid 2500.00 Total Amount to be Paid 2500.00
Rs. Two Thousand Five Hundred Only Rs. Two Thousand Five Hundred Only Rs. Two Thousand Five Hundred Only

Payment Mode: Cash/Cheque/Po No./DD N0 Payment Mode: Cash/Cheque/Po No./DD N0 Payment Mode: Cash/Cheque/Po No./DD N0

To be Paid under Account No. 01151650501086 To be Paid under Account No. 01151650501086 To be Paid under Account No. 01151650501086
Engineering Education Trust - PG with Askari Bank, Engineering Education Trust - PG with Askari Bank, Engineering Education Trust - PG with Askari Bank,
85-East, F- Block, Kamran Center, Blue Area, Islamabad 85-East, F- Block, Kamran Center, Blue Area, Islamabad 85-East, F- Block, Kamran Center, Blue Area, Islamabad
Bank Copy Account's Copy Student's Copy