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ORIGINAL - Concerned Department DUPLICATE - Applicant

Branch: Sunset Boulevard Branch, Karachi (1620) Account #: Branch: Sunset Boulevard Branch, Karachi (1620) Account #:
100-4666-8 100-4666-8

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

Annual Subscription Annual Subscription


Bank Challan Bank Challan
Fee should be deposited in UBL Booth at CPSP H.O. Fee should be deposited in UBL Booth at CPSP H.O.
Challan not to be used for Online Fee Transfer. Challan not to be used for Online Fee Transfer.

Center: Karachi Fellow Ship #: MED-01-3882 Center: Karachi Fellow Ship #: MED-01-3882

Receipt #: KHI-C-18-6505 Receipt Date: 26-05-2018 Receipt #: KHI-C-18-6505 Receipt Date: 26-05-2018

Name: AAMIR HUSSAIN Name: AAMIR HUSSAIN

Form No: 2018-2370 Form No: 2018-2370

Fee Type Amount Fee Type Amount

Annual Subscription PKR 5000 Annual Subscription PKR 5000

Total: PKR 5000 Total: PKR 5000

Amount in words: Five Thousand Only (PKR) Amount in words: Five Thousand Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________


Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

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TRIPLICATE - CPSP Finance QUADRUPLICATE - Bank

Branch: Sunset Boulevard Branch, Karachi (1620) Account #: 100-4666-8 Branch: Sunset Boulevard Branch, Karachi (1620) Account #: 100-4666-8

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

Annual Subscription Annual Subscription


Bank Challan Bank Challan
Fee should be deposited in UBL Booth at CPSP H.O. Fee should be deposited in UBL Booth at CPSP H.O.
Challan not to be used for Online Fee Transfer. Challan not to be used for Online Fee Transfer.

Center: Karachi Fellow Ship #: MED-01-3882 Center: Karachi Fellow Ship #: MED-01-3882

Receipt #: KHI-C-18-6505 Receipt Date: 26-05-2018 Receipt #: KHI-C-18-6505 Receipt Date: 26-05-2018

Name: AAMIR HUSSAIN Name: AAMIR HUSSAIN

Form No: 2018-2370 Form No: 2018-2370

Fee Type Amount Fee Type Amount

Annual Subscription PKR 5000 Annual Subscription PKR 5000

Total: PKR 5000 Total: PKR 5000

Amount in words: Five Thousand Only (PKR) Amount in words: Five Thousand Only (PKR)

____________________________ ____________________________ ____________________________ ____________________________


Candidate / Depositor Signature Receiver's Signature Candidate / Depositor Signature Receiver's Signature

Contact No: ________________ Contact No: ________________

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