Doc Code: THI – AHS – F – 01 Issue Date Issue#01 Revision Date Revision# Page 1 of 1 ADMISSION APPLICATION FORM Batch/Year: _________________________ Form Serial#___________________ This form is to be used to apply for the admission to the following Programs at Tabba Heart Institute, Affiliated with University of Karachi (UoK), Pakistan. Please indicate the course for which you wish to be considered for admission. ADMISSION FORM COMPLETION CHECK LIST Please mark all the documents, duly attested & attached with the application form. Incomplete application form and unattested documents shall not be considered Attested Copy of Matriculation Mark sheet Attested Copy of Matriculation Certificate Attested Copy of Intermediate Mark sheet Attested Copy of Intermediate Certificate Attested Copy of Consolidated Certificate Attested Copy of Graduation Degree / Transcripts Attested Copy of Valid C.N.I.C or B. Form Attested Copies of 2 references C.N.I.C Attested Copy of Experience Letters / Certificate (if any) Attested Copy HSC Part – II Admit card 12 Recent Photographs (passport size) Update CV / Resume Domicile PRC PERSONAL DETAILS: IMPORTANT INSTRUCTIONS: > Use BLOCK LETTERS to fill the form. > The Name and Father’s Name must be written as on Matriculation Certificate. > Remember to bring the Form Submission Receipt on the scheduled day of aptitude test and interview APPLICATION’S FULL NAME: ______________________________________________________________________________ FATHER’S NAME: ______________________________________________________________________________ GENDER: Male Female DATE OF BIRTH: BLOOD GROUP: ___________________________ C.N.I.C NO: RELIGION: __________________________________ POSTAL ADDRESS FOR CORRESPONDENCE: ____________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________ PROVINCE: ________________________ CITY: _______________________ COUNTRY OF RESIDENCE: ________________________________ PERMANENT ADDRESS: ____________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________ CANDIDATE’S EMAIL: ____________________________________________ PARENT’S EMAIL: _________________________________________________ CONTACT NO. RESIDENCE: ______________________________________ CANDIDATE’S MOBILE NO: _______________________________________ EMERGENCY CONTACT DETAILS: NAME OF PERSON, WHOM TO CONTACT: ______________________________________________________________________________________________________ RELATIONSHIP: ________________________________________________________ CONTACT NO: ____________________________________________________ ADDRESS: ____________________________________________________________________________________________________________________________________________ BS Medical Technology 4 Years Duration Cardiovascular Sciences (CVS) Cardiac Perfusion Sciences (CPS) Operation Theatre Sciences (OTS) M. Phil in Preventive Cardiology & Cardiac Rehabilitation 2 Years Duration Attach 01 Passport size photographs