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Registration No.
R E G IS T R AT I O N F O R M
M BB S/ B D S C ou r se s I n B a ng l ad es h
A ca de mi c Ye ar 2 014
Filled by NTS
Personal Information:
Use CAPITAL le tte rs a n d le a ve sp a ce s b e twe en wo rd s.
( City Co d e - Ph o n e No )(OFF.) (RES.) (Mobil e)
3. Name in Full:
Postal Address:
1 9
. Fathers Name:
5. Candidate CNIC# :
0. Phone No:
1. Place of Birth:
2. Pasport No:
3. Name of guardian:
4. Address of guardian:
(A). In Bangladesh:
6. Have you applied for admission in anyeducational institute in Bangladesh:
7. Name of the course to which admission is sought:
I f y e s , g i v e y ea r & d e c i s i on ,if any communicated to you
Note Candidate who desires to be considered for more than onecourse should submit separate application for each course
Yes
MBBS
No
BDS
(B). In Country of Domicile:
5. Name & Address of person to be notified in case of emergency:
Country of Birth:
Date of Issue:
Nationality:
A n y ot h e r t r a ve ldocument:
Nationality:
City:Postal City
District:
8. Email:
6. Gender:
Wr ite yo u r Co r r ect Date o f Birtho th er wise yo u will b e r ejected
Date of Birth:D M Y YD M Y Y
Male Femal e
Min istr y o f In ter Pr ovinc ialC oo r d in at io n ( IP C D iv is io n)
STN STN
. Desired Test City
Islamabad.
Lahore2.
Karachi3.
Peshawar4.
Quetta5.
Multan6.
Faisalabad7.
Fill Only One Box for Desired Test City (M andatory)
(Subject to a minimum of 200 candidates, other wise the candidates will be assigned next near est test city)
Ma nda t or y (writ e your own CNI C No also at t ached t he phot ocopy of your CNI C. O t her wise you are not Eligible )
( A l l c o r re s p on d e nc e w i l l b e m a d e o n t h i s a d d re s s )
A keyword (only 4 Digit s) provided by t he candidat e t osubmit correct ion query lat er f or correct ion in provisionalc a n d i d at e l i s t o n t h e N T S w e b s i te
. Authentication Keyword
Bank Online Deposit of Rs: 800/- from Designated Bank Branches.
B a n k N a m e & C o d e Deposit Date
* N o t e : A p p l i c a t i o n F o r m w i l l n o t b e e n t e r t a i n e d w i t h o u t O r i g i n a l D e p o s i t S l i p ( N T S C o p y ) h a v i n g B a n k S t a m p o n s l i p .
Paste your
recent
passport size
c o lo r p h ot o gr a ph
with Stapler
2 Picture
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HSSC/ A-Level( 1 2 Ye a r s De gr e e )
Language
19. Academic Information:
20. Proficiency of Language:
(Please attached your required document)
Cer tificate /Degr ee Level
Degr ee Name ObtainedMarks/CGPA
Year Passing
TotalMarks/CGPA
Institute/Boar d
SSC/ O-Level( 1 0 Ye a r s De gr e e )
Note: 1. NTS will not issue Roll No Slips to those who have not given their academic record accordingly.
M a j o r S u b j e ct
18. Domicile
Punjab1.
Balochistan3.
K h y b er P u k ht o o n kh w a2.
Sindh Urban4.
Sindh Rural5.
AJK6.
Fata Fana7.
(Mandator y)F i l l O n l y O n e B o x f o r D e s i re d D o m i c i l e
Excellent
Reading
Good Fair Excellent
Wr iting
G ood Fair E xcellent
Speaking
Good Fair
21. Cross check of basic criteria:
A. I h a ve se cu re d mo re th a n 65% marks i n SS C & H S SC o r eq u iv a le n t e x am ?
B. I have passed my SSC o r equivalent exam not before year 2009?
Yes
Yes
No
No
ndertaking By The Applicant:
_____________________________ d/ s/ w o f _________________________do hereby solemnly affirm that Ihave read and understood the conditions for appearing in the NTS Test and that I have filled the form as per instructionsgiven above and in the event any information contained herein is found to be untrue, I shall be liable to disciplinary actionwhich may result in cancellation of my test.
Date: ________________ Signature of the Candidate :__________________
S ch e du l e o f Test
Test Date: Sunday, 29th September 2013
1 1t h S e p t e mb e r 2 0 1 3Last Date of submission Application form:
By Hand submission of Application Form is not allowed.
M obile Phones are not allowed in Test Center premises.
A t t a ch y o u r r e c e nt P h o t o g ra p h , C N I C c o p y a n d O r i g in a l
Bank Deposit Slip NTS Copy.
Application should reach NTS office latest by last date of
submission of Application Form.
N T S w i l l n o t b e r e s p on s i b le f o r l a t e r e c ei v i n g o f a p p l ic a t i on
hrough courier / Pakistan Post etc.
Applications received on 12th September 2013 will not
be entertained by NTS
H el p l in e:
P h o n e N o . I S B : 0 5 1 - 92 5 8 4 78 - 7 9LHR: 042-99239258KHI: 021-35215013PES: 091-9218233
Website: www.nts.org.pkE-mail [email protected]
S en d Ap pl ic at io n F or ms t o:
M a n ag e r O p er a ti o n s
N a ti o n al T e st i ng S e r v ic e
9 6, S tr ee t N o. 4 , Se c to r H -8 /1 ,
Islamabad.
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Date:
O N L I N E D E P O S I T S L I P( * P l e a se d e po s it f e e i n o n ly o n e b a n k & t ic k t h e r e le v an t b a nk )
N a ti o n a l Te s t i ng S e r v i c eB u i l d i n g S t a n d a r ds i n E d u c a t io n a l a n d P r o f e s s i o n al Te s t i n g
Offi c e rCa shi e rCa shi e r
A/CNo.
I-8 Markaz Branch Islamabad (0140947)
NTS-P ak i st an-Col l e c t i on 0010008325640018
RemoteBranch:
A/CTitle:
(Formel y: A l l i ed B ank of P aki stan Li mi ted)
Allie dBa nk Limite d
A/CNo.
I-8 Markaz Branch, Islamabad ( 1501)
NTS-Col l e c t i on 0041749181000999
RemoteBranch:
A/CTitle:
Muslim Commercial Banku s l i m C o m m e r c i a l B a n k
Eight H u n d r ed R u p e e s O n l y.Non Ref undable/ Non Transf erable
A/CNo.
Cantt BrKashmir Road Rawalpindi (0041)
NT S- Pakistan 0205523391
RemoteBranch:
A/CTitle:
A/CNo.
H9 Shalimar Recording Co ISB (1742)
NT S-Collection 1742-79002786-03
RemoteBranch:
A/CTitle:
T H E P O W E R T O L E A D
LTD
STN STNN at i on a l T es t in g S e r v i ce
Building St andards in Educat ional and Prof essional Test ing
B ranch C ode:
B ranch Name:
Ca shi e rCa shi e rApplicant Signature
C N IC N o /B F o r m N o :
Fath erName:
Ap p lican tsName:
AmountRs:
Amou n t inword : Rs.
800/- Eight Hundr e d Rupees Only.Non Ref undable/ Non Transf erable
Not e: Bank Servi ce Charges F r e e o f C o st
Not e: Bank Servi ce Charges F r e e o f C o st
STN STN
B ranch C ode:
B ranch Name:
Applicant Signature
C N IC N o /B F o r m N o :
Fath erName:
Ap p lican tsName:
Amou n tRs:
Amou n t inword : Rs.800/-
Date:
Offi c e r
Not e: Bank Servi ce Charges F r e e o f C o s t
Not e: Bank Servi ce Charges F r e e o f C o s t
A/CNo.
I-8 Markaz Branch Islamabad (0140947)
NTS-P ak i st an-Col l e c t i on 0010008325640018
RemoteBranch:
A/CTitle:
(Formel y: A l l i ed B ank of P aki stan Li mi ted)
Allie dBa nk Limite d
A/CNo.
I-8 Markaz Branch, Islamabad (1501)
NTS-Col l e c t i on 0041749181000999
RemoteBranch:
A/CTitle:
Muslim Commercial Banku s l i m C o m m e r c i a l B a n k
A/CNo.
Cantt BrKashmir Road Rawalpindi (0041)
NT S- Pakistan 0205523391
RemoteBranch:
A/CTitle:
A/CNo.
H9 Shalimar Recording Co ISB (1742)
NT S-Collection 1742-79002786-03
RemoteBranch:
A/CTitle:
T H E P O W E R T O L E A D
LTD
Not e: Bank Servi ce Charges F r e e o f C o st
Not e: Bank Servi ce Charges F r e e o f C o st
Not e: Bank Servi ce Charges F r e e o f C o s t
Not e: Bank Servi ce Charges F r e e o f C o s t
* N o t e : D e s i r e d B a n k S t a m p i s r e q u i re d o n t he D e p o s it S l i p & S e n d O r ig i n a lD e p o s i t S l i p (N T S C o p y ) a l o n g A p p l i c at i o n F o r m t o N T S O f f i c e
Ap p lic a tio n Fo r m will n o t b e e n te r ta in e d with o u t Or ig in a l De p o s it Slip ( NTS Co p y )a
* N o t e : 1 . P l e a s e S t a m p b o t h c o p i e s o f d e p o s i t S l i p .
2 . T h e B a n k M u s t R e t u r n N T S C o p y t o t h e C a n d i d a t e..3 D e p o s i t S l i p w i l l n o t a c c ep t e d w i t h o u t C a n d i d a t e C N I C / B F o r m N o .