KHYBER MEDICAL UNIVERSITY,

PESHAWAR

INTRODUCTION:

Khyber Medical University is the one the new generation of Pakistan medical universities, established through Khyber
Medical University an Act 2006 (NWFP Act No. 1 of 2007). The University is envisaged to grow as a modern centre of
excellence in the field of Medical Sciences and technology. Khyber Medical University is committed to the provision of
intellectual leadership and development and to emerge as a beacon of light for regional Hub in scientific and
technological development in the field of health care.

KMU VISION

We aspire to raise the status of Khyber Medical University to one of the best national universities in the region ­ an
institution recognized globally for excellence in learning, research; and supporting a community of health professionals
committed to public service; and enabling the students to attain their true potential in becoming competent, caring,
and inquisitive members of the health care team

KMU MISSION

We hope to achieve our vision by:

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 Creating learning opportunities for equipping all health care providers with knowledge, skills and attitude to
deliver the highest standards of health care;
Promoting an environment of research and academic freedom informed with the principles of equal opportunity
in the pursuit and application of knowledge, aiming at the highest level of intellectual, educational and research
output and the establishment of a learning organization inculcating the highest of humanitarian values;
Conducting examinations and developing valid assessment techniques for the evaluation of knowledge, skills
and attitudes;
Providing a supportive environment to promote an attitude of life­long learning to all health care providers for
enhancing their knowledge, technical capabilities and improving their professional conduct;
Promoting collaboration and partnership with other educational and health care institutions; and
Advising and influencing the government, the public and the profession on health care issues.
KMU VALUES

Academic excellence and freedom;

Personal honesty, integrity and respect for humanitarian, traditional and cultural values;
Generation, synthesis, application and dissemination of knowledge;
Lifelong learning;
Personal and professional development of faculty and supportive staff;
Mutual respect and collaboration;
Personal, institutional and professional accountability;
Service to local, regional, national and international communities; and

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Continuous improvement of our programs through processes of sustainable development.

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 KMU INSTITUTE OF PHYSICAL MEDICINE AND REHABILITATION

INTRODUCTION
Physiotherapy help people of all ages who have physical problems that are caused by genetic disorder, birth trauma,
illnesses, accidents, or ageing. It also works with people who have mental health problems, stroke patients, and
children. An important part of a physiotherapy role involves understanding the cultural, psychological and social factors
that affect the patients.
Physiotherapy, sometimes referred to as physio, helps people to improve their range of movement in order to promote
health and well­being. This can help people to live more independently. In particular, physiotherapy concentrates on
problems that affect muscles, bones, the heart, circulation and lungs. Physiotherapy involves a range of treatments,
including manipulation, massage, exercise, electrotherapy and hydrotherapy.
Physiotherapy techniques can improve the ability to use parts of the body that are affected by disease or injury. For
example, arthritis is a long term condition that causes painful and stiff joints. Physiotherapy can help to keep the joints
mobile and strengthen the surrounding muscles.
The aim of physiotherapy is to restore proper functioning to the body. As well as treating a specific injury or illness, the
physiotherapy will also improve the general well­being and quality of life.
Physiotherapy takes a holistic approach (looking at the body as a whole rather than focusing on individual factors) to
an injury, or disease. For example, back pain can be caused by a number of factors including posture, diet, exercise
and work.
Almost all the teaching hospitals of the province have the physiotherapy departments. These are well equipped and
have dedicated staff though very deficient in number. They are fulfilling the need of the various specialties that need
their help. Unfortunately at the moment there is no institution in the province which can impart training in this important
field of health care. Those who are desirous of getting training and qualification in physiotherapy have to travel to other
provinces.

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Khyber Medical University takes this initiative and planning to establish an institute of physiotherapy and rehabilitation to
fulfill the requirements of both public and private sector. At present the institute will be located in the existing Pakistan
Institute of Prosthetic and Orthotic Sciences (PIPOS) building when PIPOS moves to its new building till a purpose built
building is constructed at a suitable place for institute. For practical training the physiotherapy departments of
Hayatabad Medical Complex, Khyber Teaching Hospital and Lady Reading Hospital will be attached to the institute.

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ADMISSION POLICY

1. Selection Criteria:
a. Admission will be open to both male and female candidates who have passed the Higher Secondary
Certificate Examination (FSc Pre­medical) or possessing an equivalent qualification from a recognized board.
b. Preference will be given to those candidates who have passed the entry test for medical colleges.
2. Allocation of seats
a. Open merit: 20 seats
These seats are open to applicants possessing valid domicile certificate for NWFP, FATA, and PATA.
b. Balochistan: 1 seat
c. Foreign: : 4 seats
If candidates from Balochistan and foreign countries do not fill all their reserved seats, the remaining
vacant seats will be converted to open merit seats.
3. Fee Structure 

S.No.  Items  Amount 

1.  Tuition Fee  (Pakistani Nationals)  Rs 20000/­ per semester 
(Foreign Nationals)  US $ 1000/­ per semester 
2.  Admission Fee  Rs 2000/­ per year 
3.  Computer Fund  Rs. 500/­  per year 
4.  Library Fund  Rs. 500/­ per year 
5.  Recreation Fund  Rs. 1000/­  per year 
6.  Laboratory Fund  Rs. 2000/­  per year 
7.  Examination Fee  (Mid term)  Rs. 500/­  per semester 
(Final)  Rs.1500/­  per semester 
8.  Security (Refundable)  Rs.1500/­ 
9.  Khyber Medical University Registration Fee Rs. 1000/­

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SELECTION AND ADMISSION OF APPLICANTS

The Admission Committee will consist of the following:

1. Principal / Director of KMU Institute of Physical Chairman

Medicine And Rehabilitation, Peshawar
2. Director Admissions and Academics KMU Secretary­cum
Member
3. Chairman Pakistan Institute of Prosthetic and
Orthotic Sciences (PIPOS) Member
4. Representative of Health Department NWFP Member

The Chairman of Admission Committee will display the merit list of each category of candidates. Objection, if any, be
submitted to the Chairman in writing who will be competent to rectify any error or omission five days before the date of
interview. The final merit list will be displayed two days before the date of interview.

The right of appeals against the decision of Admission Committee will vest in the Appellate Committee which will consist
of the following.

1. Vice Chancellor KMU Chairman

2. Registrar KMU Member­cum­Secretary
3. Chief Executive Paraplegic Centre Member

No candidate will be admitted unless he/she has paid the fee and dues. All dues must be paid by the due date,
otherwise admission will be offered to the next candidate on merit.

Library

Khyber Medical University Rules shall be applicable.

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Discipline rules and regulations

Khyber Medical University Student Conduct Rules shall be applicable.

Hostel / Accommodation

No hostel facilities are available. Student will have to arrange their own accommodation.

EXAMINATIONS

1) Method of Examination:
a) There will be continuous assessment. Mid term examination will be conducted by the institute and final
examination at the end of the semester will be conducted by Khyber Medical University, Peshawar.
b) Those candidates who fail the final semester examination will not be promoted to the next semester.

2) Registration
Students will be registered with Khyber Medical University, Peshawar within a week after the admission.

3) Medium of instruction and examination shall be English

4) Examination rules and regulations

The examination rules and regulations of KMU shall be applicable.

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FACULTY
1. Core Faculty:
1) Mr. Altaf Ahemad (Director/Principal KMU institute of Physiotherapy)
B.Sc (Physiotherapy) Karachi University, MPPS (Pak), MSOT (Germany), DEOT (Germany) HMD (England),
DPA (Peshawar University), MISPO (UK)
2) Mr. Muhammad Ibrahim (Coordinator/senior Faculty member),BS Physiotherapy (Karachi University),
SRPT (UK)
2. Provincial Faculty:
a. Staff Physiotherapy, Hayatabad Medical Complex, Peshawar
1) Mahboob Ur Rehman, B.Sc (Physiotherapy) Karachi University, MPPS (Pak), DPA (Peshawar University).
2) Muhammad Yusuf, B.Sc (Physiotherapy) Karachi University, MPPS (Pak).
b. Staff Physiotherapy, Khyber Teaching Hospital, Peshawar
3) Altaf Ahmad, B.Sc (Physiotherapy) Karachi University, MPPS (Pak), MSOT (Germany), DEOT (Germany), HMD
(England),
DPA (Peshawar University), MISPO (UK)
4) Sajida Mazhar, B.Sc (Physiotherapy) Karachi University, MPPS (Pak)
5) Muhammad Bin Afsar Jan B.Sc (physiotherapy) Karachi University, MPPS (Pak), MPT (Australia), MAPA
(Australia), MNPA (New Zealand)
c. Staff Physiotherapy, Lady Reading Hospital, Peshawar
1) Muhammad Dawood Farooqi, B.Sc (Physiotherapy) Karachi University MPPS (Pak), MSPT
2) Sami Ullah, B.Sc (Physiotherapy) Karachi University, MPPS (Pak), M.Sc (Physiology) Karachi University

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 d. Staff of PIPOS
1) Mr. Tajdar Afridi B.Sc Physiotherapy (Karachi University)
2) Mr. Liqat Ali malik B.sc Prosthetic and Orthotic
3) Mrs. Tabassum Rani B.sc Prosthetic and Orthotic
4) Mrs. Momi Gul B.sc Prosthetic and Orthotic
5) Mr. sajjad Hussain B.sc Prosthetic and Orthotic
6) Mr. Saleek Ali Syed B.sc Prosthetic and Orthotic
7) Mr. Aziz Ahemad B.sc Prosthetic and Orthotic
8) Miss Uzma Jabeen B.sc Prosthetic and Orthotic
9) Mr. Nizar Akhtar B.sc Prosthetic and Orthotic
e. Staff of Paraplegic Centre
1) Syed Muhammad Ilyas BS Physiotherapy (JPMS, Karachi)
2) Muhammad Zahoor, BS Physiotherapy (JPMS Karachi)
3. Visiting Faculty of Basic Sciences including Islamiat & Pak studies
a. Khyber Medical College, Peshawar.
b. Khyber Girls Medical College, Peshawar.
4. Visiting Faculty Clinical Sciences
a. Postgraduate Medical Institute, Peshawar
b. Khyber Medical College, Peshawar
5. National Faculty
6. International Faculty

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 COURSE OF STUDIES
The curriculum of Bachelor of Science in Physiotherapy shall extend over 4 years (8 Semester). The course is organized as follows.

Year 1, Semester 1
Credit Hours
S No Subject
Theory Practical Total
1 English 2 2
2 Islamic Studies/Moral Philosophy/Pakistan Studies 2 2
3 Anatomy­1 3 3
4 Physiology­1 2 2
5 Kinesiology & Biomechanics­1 3 1 4
6 Medical Physics 3 1 4
7 Computer skills 1 1
Total 15 3 18

Year 1, Semester 2
Credit Hours
S No Subject
Theory Practical Total
1 English 2 2
2 Islamic Studies/Moral Philosophy/Pakistan Studies 2 2
3 Anatomy­1 2 1 3
4 Physiology­1 3 1 4
5 Kinesiology & Biomechanics­1 3 1 4
6 Medical Physics 3 1 4
7 Computer skills 1 1
Total 15 5 20

Year 2, Semester 3
Credit Hours
S No Subject
Theory Practical Total
1 Sociology 1 1
2 Biostatistics 2 2
3 Anatomy­2 3 1 4
4 Physiology­2 3 1 4
5 Kinesiology & Biomechanics­2 3 1 4
6 Pharmacology & Biochemistry 3 1 4
Total 15 4 19

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Year 2, Semester 4
Credit Hours
S No Subject
Theory Practical Total
1 Sociology 1 1
2 Biostatistics 2 2
3 Anatomy­2 2 1 3
4 Physiology­2 2 1 3
5 Kinesiology & Biomechanics­2 2 1 3
6 Pharmacology & Biochemistry 2 1 3
Total 11 4 15

Year 3, Semester 5
Credit Hours
S No Subject
Theory Practical Total
1 Pathology 2 2
2 Community Medicine 2 2
3 Medicine ­1 2 2
4 Surgery­1 2 2
5 Physiotherapy Treatment, Hydrotherapy, & Clinical Practice 3 2 5
6 Electrotherapy & Actinotherapy 3 2 5
Total 14 4 18

Year 3, Semester 6
Credit Hours
S No Subject
Theory Practical Total
1 Pathology 2 2
2 Community Medicine 2 2
3 Medicine ­1 2 2
4 Surgery­1 2 2
5 Physiotherapy Treatment, Hydrotherapy, & Clinical Practice 4 2 6
6 Electrotherapy & Actinotherapy 2 1 3
Total 14 3 17

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Year 4, Semester 7
Credit Hours
S No Subject
Theory Practical Total
1 Research Methodology 1 1 2
2 Ethics & Administration 1 1
3 Medicine ­2 2 1 3
4 Surgery­2 2 1 3
5 Physiotherapy Treatment, Hydrotherapy, & Clinical Practice 3 2 5
6 Electrotherapy & Actinotherapy 3 2 5
Total 12 7 19

Year 1, Semester 8
Credit Hours
S No Subject
Theory Practical Total
1 Research Methodology 1 1
2 Ethics & Administration 1 1
3 Medicine ­2 2 2
4 Surgery­2 2 2
5 Physiotherapy Treatment, Hydrotherapy, & Clinical Practice 3 2 5
6 Electrotherapy & Actinotherapy 3 2 5
Total 12 4 16

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 DETAIL OF EXAMINATIONS
Semester 1 & 2

S.No Subject Written papers Orals and practical

1 English Paper­1 No
2 Islamic studies /moral philosophy/Pakistan studies Paper­2 No
3 Anatomy­1 Paper­3 Yes
4 Physiology­1 Paper­4 Yes
5 Kinesiology and biomechanics­1 Paper­5 Yes
6 Medical physics Paper­6 Yes
7. Computer Skills ­ Yes

Semester 3 & 4
S.No Subject Written papers Orals and practical
1 Sociology Paper­i No
2 Biostatistics Paper­2 No
3 Anatomy­ii Paper­3 Yes
4 Physiology­ii Paper­4 Yes
5 Kinesiology and biomechanics­ii Paper­5 Yes
6 Pharmacology and biochemistry Paper­6 No

Semester 5 & 6
S.No Subject Written papers Orals and practical
1 Pathology Paper­i No
2 Community medicine Paper­2 No
3 Medicine­1 Paper­3 No
4 Surgery­1 Paper­4 No
5 Physiotherapy treatment hydrotherapy & clinical practice­1 Paper­5 No
6 Electrotherapy & actinotherapy­1 Paper­6 Yes

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Semester 7 & 8

S.No Subject Written papers Orals and practical

1 Research methodology Paper­1 No

2 Ethics and administration Paper­2 No
3 Medicine – 2 Paper­3 Yes
4 Surgery –2 Paper­4 Yes
5 Physiotherapy treatment hydrotherapy & clinical practice Paper­5 Yes
6 Electrotherapy & actinotherapy Paper­6 No

SCALE OF MARKS FOR THE EXAMINATIONS

Year 1, Semester ­1

Periodical test in
S. No Examination Written Paper Total
Paper
1 English – paper –1 50 ­­­ 50
2 Islamic studies /moral philosophy/Pakistan studies­paper­2 50 ­­­ 50
3 Anatomy – 1­paper­3 75 25 100
4 Physiology –1­paper­4 75 25 100
5 Kinesiology & biomechanics–1 –paper­5 75 25 100
6 Medical physics­paper­6 75 25 100
7. Computer Skills ­ 50 50
Total 400 150 550

Semester ­2
periodical test in
S. No Examination written paper Total
paper
1 English – paper – 1 50 ­­­ 50
2 Islamic studies /moral philosophy/Pakistan studies­paper­2 50 ­­­ 50
3 Anatomy – 1­paper­3 75 25 100
4 Physiology – 1­paper­4 75 25 100
5 Kinesiology & biomechanics–i –paper­5 75 25 100
6 Medical physics­paper­6 75 25 100
7. Computer Skills ­ 50 50

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 Total 400 150 550

Year 2, Semester ­3
Periodical test in
S. NO Examination Written Paper Total
Paper
1 Sociology­paper­1 50 ­­­ 50
2 Biostatistics –paper­2 50 ­­­ 50
3 Anatomy­2­paper­3 75 25 100
4 Physiology­2­paper­4 75 25 100
5 Kinesiology and biomechanics­2­paper­5 75 ­­­ 75
6 Pharmacology and biochemistry­paper­6 75 ­­­ 75
Total 400 50 450

Semester ­4
S. NO Examination Periodical test in
Written Paper Total
Paper
1 Sociology­paper­1 50 ­­­ 50
2 Biostatistics –paper­2 50 ­­­ 50
3 Anatomy­2­paper­3 75 25 100
5 Kinesiology and biomechanics­2­paper­5 75 ­­­ 75
6 Pharmacology and biochemistry­paper­6 75 ­­­ 75
TOTAL 400 50 450

Year 3, Semester 5
Periodical test in
S. No Examination Written Paper Total
Paper
1 Pathology­paper­1 50 ­­­ 50
2 Community medicine­paper­2 50 ­­­ 50
3 Medicine­1­paper­3 50 ­­­ 50
4 Surgery­1­paper­4 50 ­­­ 50
5 Physiotherapy treatment hydrotherapy & clinical practice­1­paper­5 75 25 100
6 Electrotherapy & actinotherapy­i­paper­6 75 25 100
Total 350 50 400

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Semester 6
Periodical test in
S. No Examination Written Paper Total
Paper
1 Pathology­paper­1 50 ­­­ 50
2 Community medicine­paper­2 50 ­­­ 50
3 Medicine­1­paper­3 50 ­­­ 50
4 Surgery­1­paper­4 50 ­­­ 50
5 Physiotherapy treatment hydrotherapy & clinical practice­i­paper­5 75 25 100
6 Electrotherapy & actinotherapy­1­paper­6 75 25 100
TOTAL 350 50 400

Year 4, Semester 7
Periodical test in
S. No Examination Written Paper Total
Paper
1 Research methodology­paper­1 50 ­­­ 50
2 Ethics and administration –paper­2 50 ­­­ 50
3 Medicine – 2­paper­3 50 ­­­ 50
4 Surgery – 2­paper­4 50 ­­­ 50
5 Physiotherapy treatment hydrotherapy & clinical practice –paper­5 75 25 100
6 Electrotherapy & actinotherapy­2­paper­6 75 25 100
Total 350 50 400

Semester 8
Periodical test in
S. No Examination Written Paper Total
Paper
1 Research methodology­paper­1 50 ­­­ 50
2 Ethics and administration –paper­2 50 ­­­ 50
3 Medicine – 2­paper­3 50 ­­­ 50
4 Surgery – 2­paper­4 50 ­­­ 50
5 Physiotherapy treatment hydrotherapy & clinical practice –paper­5 75 25 100
6 Electrotherapy & actinotherapy­2­paper­6 75 25 100
Total 350 50 400

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 DISCIPLINE 
Every student and the parent/guardian of the students at the time of admission into the Institute shall give the following undertaking:­ 
UNDERTAKING/AGREEMENT 
(To be filled by the candidate on Judicial Bond of Rs. 20/­ and duly attested by the Political Agent/First Class Magistrate). 
1.  Mr. /Miss _____________________________son/daughter of _______________________________ 
resident of _____________________________________________________________________________ 
______________________________________________________________________________________ 
do hereby solemnly undertake to abide by the following:­ 
i)  That I have read the Prospectus of KMU Institute of Physical Medicine and Rehabilitation, Peshawar NWFP and hereby agree to conform to all provisions of the 
statutes of the Institute or statutes and rules as may hereafter be framed by the appropriate authorities. 
ii)  That the information furnished in, and document attached with the application  form are correct, and I fully understand that at any time during course of study, if it is 
found that any information is in­correct or any documents produced at the time of admission are false, which would have rendered me ineligible for admission under 
the rules, my name shall immediately be struck off from the Institute roll. 
iii)  That  I shall,  in case  my name is struck  off under  clause (ii) above not  be  entitled to claim refund of any  fee paid  by  me.  In addition  I shall pay to the  Principal  as 
liquidated damages at the rate of Rs. 1,00,000 (one Lac) per year of my studies in Institutes. 
iv)  That I shall have minimum attendance of 75 percent, diligently apply myself to acquire and develop the skill necessary for the practice and advancement of my study in 
order to qualify for examination and will not be promoted to the next higher class unless I have cleared all the subjects. 
v)  That I shall maintain identity as a student of Institute by wearing Institute uniform. I shall participate fully whole­heartedly in games and extra curricular activities. 
vi)  That hostel accommodation will be provided subject to availability. In case of non­availability of hostel accommodation, I will not ask for any accommodation. 
vii)  That  I will not indulge in politics of  any  type and will not be  a  member  of any political party/  organization/students Federation and holding a  gathering,  meeting  or 
taking out procession in any part of Campus, I understand that my failure to observe this clause of undertaking would result in cancellation of my admission/expulsion 
from the Institute, and that the decision of the Principal in this regard will not be challenged in any Court of Law except the Supreme Court of Pakistan. 
viii)  That  I  shall  never  use  violence,  threat  of  violence  and  pressure  in  any  dispute  with  others,  all  means  and  methods  shall  only  be  logic,  persuasion,  petition,  appeal, 
revision, review and other legal and peaceful method for settlement of differences and disputes. 
ix)  That  in any disputes with students, teachers and employees of the  Institute  I shall accept the judgment of the committee  constituted  by the  principal for decision  of 
settlement of the wrong doers. 
x)  Further, I do hereby solemnly undertake to refrain from:­ 
a)  Doing anything which may cause injury or insult to head, teacher, officers and other staff of institution. 
b)  Holding a gathering meeting or taking out procession in any part of Campus other than areas specified for the purpose. 
c)  All kinds of unfair means in examination.

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 d)  Allowing  or  abetting  the  entry  to  the  premises  of  the  Institute  of  expelled  students,  anti­social  elements  or  other  whose  presence  in  the  Campus  could  cause 
conflict amongst the students. 
e)  Bringing into the Campus, consuming or encouraging consumption of alcoholic products, drugs and narcotics and indulging in acts of moral turpitude. 
f)  Bringing or keeping any type of weapons within the University/Institute premises. 
g)  Using or occupying any room or part of any building of the Institution without lawful authority. 
h)  Subletting my hostel room to unauthorized persons. 
i)  Damaging any University/Institute property including building, equipment vehicles etc. in any manner. 
j)  Indulging in any violent or any other unsuitable activities even outside the Institute which may bring bad name to the Institute. 
k)  From all such acts and deeds as might bring disgrace and bad name to the Institute. 
xi)  In case I  am reported to be guilty/involved in any of the aforesaid activities during my stay in the medical Institute, the Institute authorities can rusticate me from the 
Institute temporarily or expel me permanently I will not try to create law and orders situation or instigate the students of the Institute or of any other institution against 
the action taken by the Institute and neither I will go to any Court of Law. In case of my expulsion from Institute I shall pay to the Principal as liquidated damages at the 
rate of Rs. 1,00,000 (one Lac) per year of my study in the Institute. 
xii)  If it is reported that I have not honored the decision of the Institute authorities as described above, I shall be liable to pay Rs. 2,00,000/­ (Two Lac) per year of my study 
in the Institute as damages to Khyber Medical University. 
xiii)  In case there is any dispute between me  on one hand and the administration of the Institute on the other hand regarding my involvement in a disciplinary  or political 
matter or regarding the imposition of any penalty or damages on me, the matter shall be referred to the Principal, as the sole arbitrator and his decision in such capacity 
shall be final and shall to be called in question in any court of law. 
xiv)  That  I will abide by the decision of the Institute Authorities in case I am found guilty  of undisciplined, defamation, disrespect of the staff and other anti­institutional 
activities. 

(Signature of the student) 

Full Name: __________________________________________ 
Father’s Name: _______________________________________ 
N. I. C. _____________________________________________ 
Permanent Address:: ___________________________________ 
___________________________________ 
Dated____________________________

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 TO BE FILLED BY FATHER/GUARDIAN OF THE CANDIDATE 

I _______________________________son/daughter/wife  of ________ ________________________and Mother/Father/Guardian of 

__________________________________________hereby fully endorse the undertaking given by my son/daughter/ward and assure that he/she will abide by this 
undertaking during his/her stay in the Institute. 
i)  I also make myself liable to pay Rs. 1,00,000 (one Lac) per year of his/her study in the Institute in case of any breach of the above mentioned undertaking by my 
son/daughter/ward Mr/Miss __________________________________ . 
ii)  I _______________________________  Father/Mother/Guardian of Mr./Miss  _________________ ____________ __________ assure that my son/daughter/ward 
will not indulge in politics of any type and will not be a member of any political party/ organization/students Federation nor will he/she attend any meeting of such result into 
his/her expulsion from the Institute, and that the decision of the Principal in this regard will be find. 
Witness­1  ____________________________ 
( Signature)  Deponent 
Signature of the Father/Guardian of the student 
Name________________________________  Full Name________________________________ 
Father’s Name_________________________  Father’s Name  ____________________________ 
Nat. Identity Card No.  __________________  Nat. Identity Card No. ______________________ 
Temporary Address  ____________________  Temporary Address ________________________ 
____________________________________  ________________________________________ 
Permanent Address _____________________  Permanent Address ________________________ 
____________________________________  ________________________________________ 
Witness­2  ____________________________ 
(Signature) 
Name________________________________ 
Father’s Name_________________________ 
Nat. Identity Card No.  __________________ 
Temporary Address  _____________________________________________________________ 
Permanent Address ___________________________________________________________

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