UNIVERSITY OF THE PUNJAB

ADMISSION FORM (Fall - 2018)

2 0 1 8 0 2 2 0 7 1
Admission Program: M.Phil Applied Geology (2 Years, Semester System)
Institute of Geology
Form No.: 0022071 (13/08/2018 03:25 PM) Received & Checked By:

PERSONAL RECORD
Name: Zia Ur Rehman Farooqi CNIC: 32304-7540899-1
Father Name: Muhammad Hussain Father CNIC: 32304-2540972-3
Occupation: Shopkeeper F. Income: 9000
(Father/Guardian) (per month)

Guardian Contact: 03336037061 D.o.B: 03/04/1996

Hafiz-e-Quran: No Religion: Islam
Marital Status: Single Gender: Male
Contact No.: 03029491583 Blood Grp: O+ve
Email: ziaurrehmanfarooqi15@gmail.com Nationality: Pakistani
Province: Punjab District: Muzaffargarh
Permanent Address: Basti Allah Abad Near Islamia School, Qalandar Wala Post Office Baseera, Tehsil And
District Muzaffargarh
Postal Address: Basti Allah Abad Near Islamia School, Qalandar Wala Post Office Baseera, Tehsil And
District Muzaffargarh

FEE RECORD
Bank Branch Challan No. Date Amount
UBL 0167 2244292 13/08/2018 500
Total Amount (In Words): Five Hundred Only Total Amount: 500

GUARDIAN DETAILS
Guardian Name Guardian Relationship

Guardian Address:

BRIEF SKETCH OF RESEARCH WORK

DETAILS OF SPECIAL NEEDS/REQUIREMENT OF ANY SUPPORT

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 REMOVED / EXPELLED DETAILS

CONVICTED DETAILS

ACADEMIC RECORD
Degree Level: Matriculation Roll# 221417 Reg.# 8-1-146031-10
Degree Title: science Year Annual - 2012
Board/Uni.: BISE DG Khan Marks 902/1050
Subjects: biology math physics chemistry Grade A+ Div. First

Degree Level: Intermediate Roll# 412685 Reg.# 8-2-212125-12

Degree Title: pre-engineering Year Annual - 2014
Board/Uni.: BISE DG Khan Marks 810/1100
Subjects: math, physics, chemistry Grade A Div. First

Degree Level: Bachelors 4-Years Roll# BGLF14M026 Reg.# 14-US-ETH-84

Degree Title: bs geology Year Semester - 2018
Board/Uni.: University of Sargodha Marks 3.68/4
Subjects: Engineering geology, Grade A+ Div. First

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 EXPERIENCE(S) RECORD
Job Title Organization Type From To
No Record Found

PUBLICATION(S) RECORD
(Only HEC Approved & ISI Web of Science Impact Factor Journals)

Paper Title Journal Volume & Page# Year

No Record Found

DECLARATION AND SIGNATURE

I, solemnly declare that:
I have neither joined nor shall join any other Institute/Department /Centre/College/School during the course of
my studies at University of the Punjab.
I am not in service /am in service (score out which does not apply). (If in service, a letter of permission from the
employer is enclosed)
I am not suffering from any infectious disease.
I understand that the University may vary or reverse any decision made on the basis of incorrect or incomplete
information which i have provided.
I have not yet attained the age of twenty four/twenty six years (only in-case of Graduate or Masters Level
programs applicants).
I have read and understood the University's cancellation and refund policy.
I understand that the University may obtain official record from any educational institution I have previously
attended.
The entries made in this form are correct.

I, undertake to:
1. Abide by the Statutes, regulations (including the Code of Honour of Students, of University Calendar 1990 Vol.
1) and rules etc. framed by the University of the Department/Institute/Centre/College/School from time to time
and shall be liable to any penalty including rusticatino/expulsion, incase of violation on my part.
2. I accept as a condition of my admission the authority of the University that a student can be required to
withdraw his name from the rolls, if in the opinion of the Vice-Chancellor/Director/Chairman/Principal of the
Department/Centre/College, his stay is not conducive to the welfare, either of himself or others in the
Department/Institute/Centre/College/School. If the undersigned (student) fail to withdraw my name immediately
after being called upon to do so, it may be struck off the rolls of the Department/Institute/Centre/College/School
without any further notice to me.
3. I am joining this class with the express consent of my father / guardian, who agrees to be responsible for my
good conduct and has appended his signature below in token thereof.
4. Not to "indulge in politics", and in case, I violate this undertaking an "induge in politics" after my admission by
the University, I shall be liable of expulsion without any notice under the order of the Vice-Chancellor which
order shall be final and can be questioned only before the Supreme Court of Pakistan vide judgment/order of
the Supreme Court of Pakistan dated 01 July 1992.
5. I accept as binding on me as long as i am a student, all rules and regulations in force at the time of joining an
which might be framed subsequently.
6. Show good behaiour.
7. Devote whole-heartedly to my studies and maintain the dignity and prestige of the University both in and
outside the Campuses.
8. Pay in time all dues and fine, if any.
9. I will notify the new address to Admission Committee (in-case of Graduate & Master level degree program) &
Assistant Registrar, DPCC (in-case of MS/M.Phil & Ph.D level degree program), if there is any change in my
contact address/phone number.
10. I undertake to take examination unconditionally notified by the Department/Institute/Centre/College/School.
11. Errors and Omissions excepted (E&OE) and University of the Punjab is not liable to respond any legal or court
proceedings.
12. I have read the relevant rules and regulations concerning admission before signing this application.

(Signature of Father/Guardian) (Signature of the Applicant) Date: _________________

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 CHECK LIST
Have You:
Enclosed a letter of permission from the employer (for employees only).
Enclosed a certificate of experience from the employer (for employees only).
Enclosed attested / certified copies of your all academic transcripts (including certified translation if necessary).
Enclosed migration certificate (if graduated from a University other than the University of the Punjab.
Enclosed a certificate of good moral character.
Enclosed an attested copy of the National Identity Card / Domicile Certificate.
Enclosed an attested copy of the National Identity Card of Applicant's Father/Guardian.
Enclosed an attested copy of the Certificate of Hafiz-e-Quran (if applicable).
Enclosed an Entry Test result slip (if applicable).
Note:
All relevant documents be attached by the candidate with his/her application form (entered in form).
No benefit would be given for any document not attached at the time of submitting application or produced
after the closing date of admission.
Applicants shall submit their original documents at the time of admission.

FOR OFFICE USE ONLY

Evaluation Record Admission Status
Matric Admitted: Yes No
F.A/F.Sc
B.A/B.Sc
M.A/M.Sc/LL.B
(Pharm-D or 16/17 Year Education)

MS/M.Phil
(18 Year Education) Director/Chairman/Chairperson/Principal
Teaching/Research Exp.
Written Test
Interview
Total Merit
Remarks: Chairman/Chairperson DPCC/Admission Committee

Cut the postal address written below the line and paste on your Courier Envelope

POSTAL ADDRESS FOR ADMISSION FORM

ADMISSION OFFICE (MS/M.Phil),
Institute of Geology,
Quaid-i-Azam Campus,
University of the Punjab,
Lahore.

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