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College of Physicians & Surgeons Pakistan: Online Application Form (FCPS-I) Examination

This document is an online application form submitted by OZAIR BILAL AHMED for the FCPS-I examination in June 2020 as a repeater candidate. It provides his personal details like name, father's name, address, contact information, as well as details of the last exam he appeared for. It also shows that he has selected Surgery and Allied as his speciality and paid a fee of PKR 25,000 through debit/credit card for appearing in the exam at the Multan examination center.

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Usama Bilal
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358 views2 pages

College of Physicians & Surgeons Pakistan: Online Application Form (FCPS-I) Examination

This document is an online application form submitted by OZAIR BILAL AHMED for the FCPS-I examination in June 2020 as a repeater candidate. It provides his personal details like name, father's name, address, contact information, as well as details of the last exam he appeared for. It also shows that he has selected Surgery and Allied as his speciality and paid a fee of PKR 25,000 through debit/credit card for appearing in the exam at the Multan examination center.

Uploaded by

Usama Bilal
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
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College of Physicians & Surgeons Pakistan Repeater

Form No: 769-220181


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

Online Application Form (FCPS-I) Examination

Term: 15-JUN-2020
Registration Type: Repeater
Enrolment No: F-20-00360
Examination Center: MULTAN
Selected Speciality: SURGERY AND ALLIED
Fee Type: Debit/Credit Card Fee Amount PKR 25000
Fee Submission City Lahore Transaction ID: 210762545775
Receipt #: LHR-O-20-10503 Receipt Date: 21-05-2020

Profile Information
Medical Reg. No: 100536-P
Medical Reg. issue date: 19-12-2018 Medical Reg. expiry date: 31-12-2022
Full Name: OZAIR BILAL AHMED
Father's name: BILAL AHMAD
Nationality: Pakistan Identity Card No: 31102-2633746-3
Gender: Male Marital Status: Single
Date of Birth: 25-12-1993
Email: ozairbilal@live.com

Present/Mailing Address (Residential Only)


Address: HOUSE NUMBER 97, BEHIND FATIMA PLAZA OLD EID GAH ROAD
Chishtian, Punjab, Pakistan
Tel (Res.): 0632440077 Tel (Office):
Cell: 03007877134 Postal Code:

Permanent Address (Residential Only)


Same as Mailing Add: Yes
Address: HOUSE NUMBER 97, BEHIND FATIMA PLAZA OLD EID GAH ROAD
Chishtian, Punjab, Pakistan
Tel (Res.): 0632440077 Tel (Office):
Cell: 03007877134 Postal Code:

Particulars of Last Examination Appeared


Roll Number: 61512 Date of Examination:
Enrolment: F-20-00360 Center:

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: 21-05-2020

Note:

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

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ORIGINAL - Concerned Department DUPLICATE - Applicant

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

Debit/Credit Card Debit/Credit Card

Center: Lahore PMDC/En.No: F-20-00360 Center: Lahore PMDC/En.No: F-20-00360


Receipt #: LHR-O-20-10503 Date: 21-05-2020 Receipt #: LHR-O-20-10503 Date: 21-05-2020
Name: OZAIR BILAL AHMED Name: OZAIR BILAL AHMED
Trans ID: 210762545775 Approval Code: 381352 Trans ID: 210762545775 Approval Code: 381352

Form No: 769-220181 Form No: 769-220181

Fee Type Session Amount Fee Type Session Amount

Exam Fee - FCPS-I JUN-2020 PKR 25000 Exam Fee - FCPS-I JUN-2020 PKR 25000

Bank Service Charges PKR 925 Bank Service Charges PKR 925

Total: PKR 25925 Total: PKR 25925

Amount in words: Twenty-Five Thousand Nine Hundred and Twenty-Five Only (PKR) Amount in words: Twenty-Five Thousand Nine Hundred and Twenty-Five Only (PKR)

Note: Note:
In case of any refund/charge back against cards transaction through internet payment In case of any refund/charge back against cards transaction through internet payment
gateway, the candidate should claim the refund/charge back from CPSP directly. gateway, the candidate should claim the refund/charge back from CPSP directly.

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