Paste One Passport Size by wia20667

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									  For Office Use

                                                                                      Paste One
No……………………                                                                          Passport Size
Date …………………
                                                                                     Photograph

Received by…….……

            FRONTIER MEDICAL & DENTAL COLLEGE
                                  ABBOTTABAD, PAKISTAN

                Admission Application Form for MBBS / BDS
                            a. MBBS            b. BDS

 1. Seat applied for        Open Merit              Overseas Pakistanis        Foreign National
 2.     Boarder             Day Scholar
 3. Name ……………………………………… 4. Father’s Name ………………………….…..
 5. Full Postal Address ……………………………………………………………………………
      ………………………………………………………………………………………………….
      ………………………………………………………………………………………………….
      .Phone (Res) …………………… (Fax) .………………………..e-mail ….………………….
 6. Date of Birth ……….……..7. Place of Birth ......……………….. 8. Sex: …………………..
 9. Nationality ………………… 10. Domicile ………………… 11. Religion ………………….
 12. Fathers or Guardians name, occupation/profession, exact position held & Postal Address:
      Name: ……………………………………….. Profession / Occupation: ……………………..
      Address: ………………………………………………………………………………………..
      ………………………………………………………………………………………………….
      Phone (Res) ………………………(Fax) ……………..………..e-mail………………............
 13. Education/Qualifications:
                                   Year of    Marks     Total      Name of the         Name of the
      Qualifications               Passing   Obtained   Marks    Board/University     School/College
      Matriculation:
      (Secondary School)
      F.Sc. Pre Med:
      (Higher Secondary School)

 14. Qualifications other than F.Sc. like the British G.C.E ‘A’ level or American High School or
      similar qualifications / degrees ……………….……… Year of Passing ……………………
      Subjects passed with grades …………………………………………………………………...
      School/College with address …………………………………………………………………..
 15. Any Special Achievement ……………………………………………………………………..

                       (This form should be completely filled in capital letters)
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16. Extra curricular activities: a. Hobbies:…………………………b. Sports:……………………
   c. Debates:………...………………………. d. Literary:………………………………………
   e. Computer Knowledge: Yes  No  detail:……………………………………………...
17. Who will bear the Cost of your Education, name & relation:…………………………….........
   His exact Occupation/Profession:………………………………………………………..…….
   Exact position held if in service:……….………………………………………………………
   Full Postal Address:……………………………………………………………………………
   ………………………………………………………………………………………………….
   Phone (Res) …………………(Fax)……..……………………e-mail: .……………………..
18. Are you physically fit Yes   No   , if not mention the problem:…………………….………
19. Do you smoke? Yes      No      if yes, how many cigarettes you smoke per week: ………….
20. Have you ever been convicted in a court of law Yes       No     , if yes then when and
   What for: …………………………………………………………………………………….
21. Have you ever been admitted in any Medical/Dental College before     Yes        No
   If yes where and when?……………………………………………………………………
22. Have you been vaccinated against Hepatitis Yes        No
   If Yes where and when? ……………………………………………………………………….
23. The following attested photo-copies of the certificates etc. should be attached with the
   application:
   a. A Copy of Detail Marks Certificate of the examination on basis of which admission is
       sought. (F.Sc. pre medical or similar examination like the British G.C.E ‘A’ level or
       American / Canadian High School Certificate with grades etc.)
   b. A copy of Secondary School Certificate Examination (Matriculation or O-Level)
   c. A copy of the merit certificate of the Entry Test conducted by the provincial govt. of the
       province of the domicile of the candidate.
   d. A copy of National Identity Card or form B.
    e. For Foreign and Overseas applicants photocopies of the four pages of Passport.
   f. A copy of the Domicile / Residence Certificate.
   g. A copy of Character Certificate from Head of the institution last attended.
   h. A copy of any other educational achievement or co-curricular activity Certificate that an
       applicant wishes to be considered.
   i. A Medical Certificate duly signed by a registered medical doctor regarding physical
       fitness.
   j. A certificate that you have received proper Hepatitis B vaccine.
   k. Six Copies of passport size (2 x 2 inches) colour photograph of the applicant.



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* 24. Fees:

     a.       Tuition Fee
              In addition to teaching & training, this includes the fee for conducting House examinations;
              Internal Assessment, Mid-Term and Pre-Professional examination; Documents Verification
              fee; Medical check up and the cost of Health Insurance and security provision etc.

                 Rs.400,000/- per academic year for Open Merit students.
                 US$ 12000/- per academic year for Foreign students.
                 US$ 8000/- per academic year for Overseas Pakistani students.
       b.   Rs.15,000/- Fee for Registration with PMDC, the University, Health Regulatory
                        Authority, Higher Education Regulatory Authority
       c. Admission Fee
                 Rs.60000/- to be paid once at the time of admission
       d. Caution Money (Refundable)
                 Rs.30000/- to be paid only once on admission and refundable after adjustments
                 on leaving the college
       e. Student Activities and other Miscellaneous Fees
                 Rs.10000/- per academic session. This includes cost of transport, social and other
                 activities, camps, study tours to rural areas, sports fee and correspondence fee.
          f. Hostel fees
              These fees are payable only by those students who reside in college hostels.
              i. Hostel, Boarding and Lodging Fee
                 Rs.120,000/- per academic session of one year. This includes hostel
                 accommodation, cost of food, cost of maintenance, services of warden /
                 housekeepers, cooks, bearers, cleaners, chowkidars and provision of furniture,
                 cutlery, crockery, cooking utensils and common room facilities and provision of
                 security arrangements etc.
              ii. Hostel Security (Refundable)
                  Rs.5,000/- Refundable after adjustments on leaving the hostel.
          g. Notes: -
                   i. Fees once paid are not refundable except the Caution Money and Hostel
                      Security.
                  ii. Hostel fee will not be refundable if the resident leaves the hostel during the
                      session or at any time.
          h. Merit Awards
                  i.   Merit Award of Rs.100,000 is awarded to students who score over 85%
                       marks in the Entry Test.
                  ii. Students securing over 85% marks and standing First in their any annual
                       professional university examinations will also receive an award of
                       Rs.100000 for the year concerned.
                  iii. Students securing over 85% marks in any subject in the university
                       examination will be awarded merit citation and a gold medal at the
                       Convocation.

          *   Tuition Fees are under review
                                                                         …………………………………
       Dated: ……………………..                                                  Signature of the Applicant

                                                                                                        3
25. Declaration:

     a. I, Mr. / Miss……………………………………S/D/O……..…………………………
        declare that I have made the correct statements. If any statement is found false I shall
        be disqualified for admission and continuing studies.
     b. I shall fully abide by the college rules and regulations as at present and to be
        announced by the college from time to time.
     c. I have carefully read the item # 24 above and fully understand and agree to abide by
        the contents.


         ……………………………                            NIC.No.               -                         -
         (Signature of the applicant)

         (Passport No. in case of foreign applicants …………………………………………….)
         Issued on …………………………………………. at ……………………………….…
26. Declaration by Father / Guardian:

   I, Mr./ Mrs. …………………………………………………………………………………….

   father /guardian of ……………………………………………………………………….……
   certify that my son / daughter / ward is applying for admission in MBBS / BDS course,
   which is of five/four years duration at Frontier Medical College, Abbottabad with my
   permission. He / she has made correct entries and I endorse his/her declaration. I undertake
   to arrange payment of his/her fees and other dues regularly on yearly basis during the 1 st
   month after start of each session without delay. I further assure that my son/daughter/ward
   will strictly abide by the rules and regulations of the college. I accept and agree to all the
   present and future decisions of the college authorities.


   ……………………………………………                                 NIC No.              -                 -
   (Signature of Father/Guardian of the applicant)

   (Passport No. in case of foreign applicants ……………………………………………...…)
   Issued on …………………………………………. at ……………………………….…...…..
27. Important Note:

     This completed application form accompanied with a demand draft of Rs.1000 from
     within Pakistan and US$ 100 from foreign and overseas applicants in the name of
     Frontier Medical college, as the Admission Processing Fee should be submitted /
     mailed on the following address:




                           FRONTIER MEDICAL COLLEGE
                                    Admission Office
                       P.O. PUBLIC SCHOOL, MANSEHRA ROAD
                               ABBOTTABAD – PAKISTAN
                Phone: 92-992-382631/ 383568 & 380190 Fax: 92-992-381028
                 E-mail: fmcollege@yahoo.com, Website: www.fmc.edu.pk

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