College of Physicians & Surgeons Pakistan Form No: 125-138091
Training Session: Jan-2025
7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606 Application Date: 15-02-2025
Website: www.cpsp.edu.pk
FCPS-II Training Registration Form
Full Name: ALI QADIR
Father's Name: PARVAIZ AKHTAR
Nationality: Pakistan
NIC No: 36501-2585203-9
Date of Birth: 23-07-1999
Gender/Marital Status: Male / Single
Email: Aliqadiir@gmail.com PMDC No: 922181-01-M
Registration Information
Program: 1st Fellowship
Speciality: SURGERY
Country/State/City: Pakistan, Punjab, Lahore
Institute: SIMS / SERVICES HOSPITAL
Supervisor: JAVAID UR REHMAN ASHRAF Unit/Department: 4
Joining Date: 15-02-2025
Training Option: Will move to sub-speciality after General Surgery rotation
Subspeciality Group: Group 2
Present/Mailing Address (Residential Only)
Address: ROOM 05, DOCTORS HOSTEL, SHAIKH ZAYED MEDICAL COMPLEX
Country/State/City: Lahore, Punjab, Pakistan
Tel (Res.): 03326083115 Tel (Office):
Cell: 03326083115 Postal Code: 54600
Permanent Address (Residential Only)
Same as Mailing Add: No
Address: CHAK 115/12.L
Country/State/City: Chichawatni, Punjab, Pakistan
Tel (Res.): 03326083115 Tel (Office):
Cell: 03326083115 Postal Code: 57200
Basic Medical Qualification
Degree/Diploma: MBBS Passing Year: 2023
City/State/Country: Lahore, Punjab, Pakistan
Institute:
FCPS-I Information
Speciality: SURGERY AND ALLIED Roll No: 62189
Enrolment No: F-24-08212 Session Date:
Fee Information
Form Submission Center Lahore Transaction ID: 5650cb3c-67d8-43b8-9516-47c122bb7a53
Receipt #: LHR-O-25-6175 Receipt Date: 15-02-2025
Note:
Overwriting is not allowed on the hard copy of the application form nor any candidate is allowed to change his/her particular electronically
otherwise form may be rejected.
This application is valid for 4 months only. If rejected/ unaccepted it has to be resubmitted with registration fees.
page 1 / 3
College of Physicians & Surgeons Pakistan Form No: 125-138091
Training Session: Jan-2025
7th Central Street, Defence Housing Authority Phase-II, Karachi -75500, Pakistan
Tel: 99207100-09 , Fax: 99207120, 35881444, UAN: 111-606-606 Application Date: 15-02-2025
Website: www.cpsp.edu.pk
Supervisor's Consent
Name of Candidate: ALI QADIR
Institute & Dept.: SIMS / SERVICES HOSPITAL, 4
I am willing to supervise the above named FCPS-II trainee in the speciality of SURGERY. I declare that trainee is
not my close relative.
Name of head of institution/Dean PGMI: _______________________________
Signature and stamp of head of institution/Dean PGMI: _______________________________
Name of supervisor: _______________________________
Signature of supervisor with stamp and RTMC #: _________________________________________________
Note: Prof. M. Shoaib Shahfi, Vice President & RD, CPSP RC-Islamabad, has submitted a letter #F.1-2/CPSP-ID/Admin/21, dated 24th November, 2021
which is selfexplanatory and reproduced below.
"Must Show stipend amount in appointment letter instead of paid trainee, and strictly apply from Jan, 2022 RTMC Session."
Declaration
* The information given by me in this form is entirely correct. I am fully aware of the fact that in case a candidate gives wrong information on any
account, he/she is liable to punitive action by the CPSP, which may include cancellation of the registration and debarring from appearing in CPSP
RTMC for such period as may be specified by the CPSP.
* I undertake to keep the CPSP informed of the progress of training from time to time, as required. I also undertake to inform CPSP promptly in case of
transfer / change of supervisor, failing which the unregistered period of training is liable for cancellation besides imposing such penalty as may be
specified by CPSP.
* I declare that supervisor is not my close relative.
* I understand that in RTMC Registration any type of fee is not refundable.
Signature of Candidate: ________________________________ Dated: 15-02-2025
Original Documents to be upload in step-2:
Step1 complete application form duly signed by Supervisor, Head of Institute and yourself as an applicant.
Scan copy of Paid Challan/ Pay Order/ Demand Draft.
One recent colour photograph with clear identity and attested from front.
Valid PMDC registration certificate.
FCPS part 1 result / exemption letter.
Appointment / placement order issued by institution's administration department.
Letter of joining from the department.
MBBS/BDS degree.
If there is any change in particulars please attach your written application.
Details required.
No. of trainee registered with the proposed supervisor
No. of beds in the relevant unit
Faculty members in the unit, duly verified from the head of institute
page 2 / 3
ORIGINAL - Concerned Department DUPLICATE - Applicant
College of Physicians and Surgeons Pakistan College of Physicians and Surgeons Pakistan
RTMC RTMC
Debit/Credit Card Debit/Credit Card
Center: Lahore PMDC/En.No: F-24-08212 Center: Lahore PMDC/En.No: F-24-08212
Receipt #: LHR-O-25-6175 Date: 15-02-2025 Receipt #: LHR-O-25-6175 Date: 15-02-2025
Name: ALI QADIR Name: ALI QADIR
Trans ID: 50cb3c-67d8-43b8-951 Approval Code: 504161 Trans ID: 50cb3c-67d8-43b8-951 Approval Code: 504161
Form No: 125-138091 Form No: 125-138091
Fee Type Session Amount Fee Type Session Amount
Registration Fee - FCPS Trainees Jan-2025 PKR 5000.00/= Registration Fee - FCPS Trainees Jan-2025 PKR 5000.00/=
Bank Service Charges PKR 80.00/= Bank Service Charges PKR 80.00/=
Total: PKR 5080.00/= Total: PKR 5080.00/=
Amount in words: Five Thousand and Eigthy Only (PKR) Amount in words: Five Thousand and Eigthy Only (PKR)
Terms & Conditions: Terms & Conditions:
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.
page 3 / 3
