Scribd
Upload
95 views2 pages

Online Application PDF

Hina Abbas seeks to change her subject for the FCPS-I examination from Community Medicine to Medicine and Allied. She is registered to take the exam in Islamabad in February 2021. She has submitted an application and paid a fee of PKR 5000 via bank instrument at the Form Submission Center in Muzaffarabad to process the subject change request. The document provides her personal and contact details as well as professional qualifications to process the request.

Uploaded by

Azhar Ali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
95 views2 pages

Online Application PDF

Hina Abbas seeks to change her subject for the FCPS-I examination from Community Medicine to Medicine and Allied. She is registered to take the exam in Islamabad in February 2021. She has submitted an application and paid a fee of PKR 5000 via bank instrument at the Form Submission Center in Muzaffarabad to process the subject change request. The document provides her personal and contact details as well as professional qualifications to process the request.

Uploaded by

Azhar Ali
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

College of Physicians & Surgeons Pakistan Form No: CR-2021-1673

7th Central Street, Defence Housing Authority, Karachi -75500, Pakistan Date: 09-02-2021
Tel: 9207100-09 , Fax: 9207120, 5881444, UAN: 111-606-606
Website: www.cpsp.edu.pk

Change Request / Withdrawal Application (FCPS-I) Examination

Request: Change Subject


From Subject: COMMUNITY MEDICINE
To Subject: MEDICINE AND ALLIED
Term: 16-FEB-2021
Registration Type: Fresh
Examination Center: ISLAMABAD
Selected Speciality: COMMUNITY MEDICINE
Fee Type: Instrument (PO/DD/Cheque) Fee Amount
Form Submission Center Muzaffarabad
Receipt #: MUZ-I-21-134 Receipt Date: 09-02-2021
Number: 16940635 Date: 02/08/2021
Bank Name: United Bank Limited Bank City: Muzaffarabad
Branch Name: MAIN BAZAR CHATTAR AK (1106)

Profile Information
Medical Reg. No: 4124-AJK
Medical Reg. issue date: 04-01-2017 Medical Reg. expiry date: 31-12-2021
Full Name: HINA ASIF ABBASI
Father's name: MUHAMMAD ASIF ABBASI
Nationality: Pakistan Identity Card No: 81302-8270520-4
Gender: Female Marital Status: Single
Date of Birth: 29-10-2020
Email: azhar_gl@hotmail.com

Present/Mailing Address (Residential Only)


Address: C/O ANUM ASIF ABBASI,DIRECTOR ADMINISTRATION,AJK TEVTA UPPER CHATTER ,
Muzaffarabad, Azad Kashmir, Pakistan
Tel (Res.): 05822921547 Tel (Office):
Cell: 03481515505 Postal Code:

Permanent Address (Residential Only)


Same as Mailing Add: No
Address: C/O ANUM ASIF ABBASI,DIRECTOR ADMINISTRATION,AJK TEVTA UPPER CHATTER ,
Muzaffarabad, Azad Kashmir, Pakistan
Tel (Res.): 05822921547 Tel (Office):
Cell: 03481515505 Postal Code:

Professional Qualification
Degree: Passing Year:
Institute:
City/State/Country: ,,

Declaration
do hereby declare that information given above is correct to the best of my knowledge. Incorrect information may lead to cancelation of enrollment /
admission / results and disciplinary action.

Signature of Candidate: ________________________________


Dated: 09-02-2021

Note: Once entered in the application the center and subject will only be changed after submission of prescribed fee for this change.

page 1 / 2
ORIGINAL - Concerned Department DUPLICATE - CPSP Finance TRIPLICATE - Applicant

College of Physicians and Surgeons College of Physicians and Surgeons College of Physicians and Surgeons
Pakistan Pakistan Pakistan

Change of Centre / Speciality Change of Centre / Speciality Change of Centre / Speciality


Bank Instrument - Fee Receipt Bank Instrument - Fee Receipt Bank Instrument - Fee Receipt
(Pay Order/Demand Draft) (Pay Order/Demand Draft) (Pay Order/Demand Draft)

Center: Muzaffarabad Center: Muzaffarabad Center: Muzaffarabad


Reg/Enrol No: 4124-AJK Reg/Enrol No: 4124-AJK Reg/Enrol No: 4124-AJK
Receipt #: MUZ-I-21-134 Date: 09-02-2021 Receipt #: MUZ-I-21-134 Date: 09-02-2021 Receipt #: MUZ-I-21-134 Date: 09-02-2021
Name: HINA ASIF ABBASI Name: HINA ASIF ABBASI Name: HINA ASIF ABBASI

PO/DD #: 16940635 Date: 02/08/2021 PO/DD #: 16940635 Date: 02/08/2021 PO/DD #: 16940635 Date: 02/08/2021
Bank Name: United Bank Limited Bank Name: United Bank Limited Bank Name: United Bank Limited
Branch: MAIN BAZAR CHATTAR AK (1106) Branch: MAIN BAZAR CHATTAR AK (1106) Branch: MAIN BAZAR CHATTAR AK (1106)
Branch City: Muzaffarabad Branch City: Muzaffarabad Branch City: Muzaffarabad
Form No: CR-2021-1673 Form No: CR-2021-1673 Form No: CR-2021-1673

Fee Type Term Amount Fee Type Term Amount

Change of FEB-2021 PKR 5000 Change of FEB-2021 PKR 5000


Centre/Speciality Fee Type Term Amount Centre/Speciality

Change of FEB-2021 PKR 5000


Centre/Speciality

Total: PKR 5000 Total: PKR 5000

Amount in words: Five Thousand Only Amount in words: Five Thousand Only
(PKR) Total: PKR 5000 (PKR)

Amount in words: Five Thousand Only


(PKR)

_________________________ _________________ _________________________ _________________


_________________________ _________________
Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature
Candidate / Depositor Signature Receiver's Signature
Contact No: ________________ Contact No: ________________
Contact No: ________________

page 2 / 2

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy