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    Course Registration Form: Sayyedha Sidrah Nisar Muhammad Nisar Khan

    Uploaded by

    Ali Syed
    1. Sayyedha Sidrah Nisar is registering for the Basic Life Support Provider Course to be held in Islamabad in December 2020. She is pursuing an FCPS in Diagnostic Radiology. 2. The form provides her personal details like name, father's name, date of birth, address and contact information. 3. It also includes details of the course, fees paid, and her signature declaring the information is correct.

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    Course Registration Form: Sayyedha Sidrah Nisar Muhammad Nisar Khan

    Uploaded by

    Ali Syed
    67 views2 pages
    1. Sayyedha Sidrah Nisar is registering for the Basic Life Support Provider Course to be held in Islamabad in December 2020. She is pursuing an FCPS in Diagnostic Radiology. 2. The form provides her personal details like name, father's name, date of birth, address and contact information. 3. It also includes details of the course, fees paid, and her signature declaring the information is correct.

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    1. Sayyedha Sidrah Nisar is registering for the Basic Life Support Provider Course to be held in Islamabad in December 2020. She is pursuing an FCPS in Diagnostic Radiology. 2. The form provides her personal details like name, father's name, date of birth, address and contact information. 3. It also includes details of the course, fees paid, and her signature declaring the information is correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    67 views2 pages

    Course Registration Form: Sayyedha Sidrah Nisar Muhammad Nisar Khan

    Uploaded by

    Ali Syed
    1. Sayyedha Sidrah Nisar is registering for the Basic Life Support Provider Course to be held in Islamabad in December 2020. She is pursuing an FCPS in Diagnostic Radiology. 2. The form provides her personal details like name, father's name, date of birth, address and contact information. 3. It also includes details of the course, fees paid, and her signature declaring the information is correct.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Form No: 2020-14778 Course Registration Form Application Date: 19-01-2020

    Full Name: SAYYEDHA SIDRAH NISAR


    Father's Name: MUHAMMAD NISAR KHAN
    New NIC: 11101-2601163-0
    Date of Birth: 01-04-1988
    Gender/Marital Status: Female / Married
    Email: sidrairfan17@yahoo.com

    Registration Information
    Program: FCPS Speciality: DIAGNOSTIC RADIOLOGY
    Country/State/City: Pakistan, Punjab, Rawalpindi
    Institute: MILITARY HOSPITAL
    Supervisor: SAERAH IFFAT ZAFAR Unit/Department:
    RTMC #: RAD-2019-124-2749 CPSP ID: 2019-62

    Course(s) Details
    # Course Name Center Expected Exam Date

    1 Basic Life Support Provider Course ISLAMABAD December, 2020

    Present/Mailing Address (Residential Only)


    Address: FLAT E BLOCK D9 CMT GOLRA FLATS PESHAWAR ROAD RAWALPINDI
    Country/State/City: Rawalpindi, Punjab, Pakistan
    Tel (Res.): - Tel (Office):
    Cell: 03324186798 Postal Code:

    Permanent Address (Residential Only)


    Address: FLAT E, BLOCK 53, LANE 4 ASKARI 7
    Country/State/City: Rawalpindi, Punjab, Pakistan
    Tel (Res.): - Tel (Office):
    Cell: 03324186798 Postal Code:

    Fee Information
    Form Submission Center Rawalpindi Transaction ID: 220050576345
    Receipt #: RWP-O-20-99 Receipt Date: 19-01-2020

    Declaration
    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: 19-01-2020

    Overwriting or electronic change is not allowed on the hard copy of this application form otherwise form may be rejected.
    Candidates are advised to attach a hand written application if they want to change their particulars.

    page 1 / 2
    ORIGINAL - Concerned Department DUPLICATE - Applicant

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

    Debit/Credit Card Debit/Credit Card

    Center: Rawalpindi CPSP ID: 2019-62 Center: Rawalpindi CPSP ID: 2019-62
    Receipt #: RWP-O-20-99 Date: 19-01-2020 Receipt #: RWP-O-20-99 Date: 19-01-2020
    Name: SAYYEDHA SIDRAH NISAR Name: SAYYEDHA SIDRAH NISAR
    Trans ID: 220050576345 Approval Code: 406008 Trans ID: 220050576345 Approval Code: 406008

    Form No: 2020-14778 Form No: 2020-14778

    Fee Type Amount Fee Type Amount

    Course Fee - BLS PKR 8000.00 Course Fee - BLS PKR 8000.00

    Bank Services Charges PKR 280.00 Bank Services Charges PKR 280.00

    Total: PKR 8280.00 Total: PKR 8280.00

    Amount in words: Eight Thousand Two Hundred and Eigthy Only (PKR) Amount in words: Eight Thousand Two Hundred and Eigthy 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.

    page 2 / 2

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