2-year Community Midwifery Course

Institute of Public Health, Nursing and Midwifery-Global Institute of Human Development (IPHN&M-GIHD)

APPLICATION FORM
FOR
2-year Community Midwifery Course
Important Instructions

Step 1: Submit Application Form online

Step 2: Deposit your application fee of Rs. 1000/- through online transfer or bank draft. Bank details are as below:

Account Title: Global Institute of Human Development
IBAN: PK97 SAUD 0050 7550 00546528
Silk Bank F-8 Branch, Islamabad

EasyPaisa Account number: 0301 5568 578

Account IBAN: PK58TMFB0000000058173879

Step 3: WhatsApp the deposit slip of the application fee on WhatsApp at 0330-2000397,0330-2000398.

* Submission Deadline: 15th October, 2024

Fee Structure:
PERSONAL DATA
Name (As per matriculation record)*
Father Name*
Marital Status*
Marital Status*

MarriedSingleDivorcedWidowSeparated
Date of Birth*

DayMonthYear
Age*
Domicile*
Province*
Religion*
NIC Card No/ B Form Registration No:*
CNIC : 00000-0000000-0
Father/Guardian’s NIC No*
CNIC : 00000-0000000-0
Name of the Guardian (if applicable)
Relationship with Guardian
Father/Guardian’s monthly income*
Postal Address*
Permanent Home Address*
Phone No.Res*
051-0000000
Mobile*
+92-123-0000000
Email*
example@example.com
Qualification*

F.Sc/FA (optional)Matric in Science/ArtsOther Qualification
Dated*

MonthDayYear
Date
Signature of Applicant

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If admitted, I hereby declare to:
- abide by the rules and regulations in force at present or that may hereafter be made by the authorities concerned and undertake that throughout the training period.
- do nothing either inside or outside the institute premises that will interfere with its administration and discipline.
- not work during my academic tenure
I also hereby declare that in case I fail to comply with the above at any stage, I will be liable to any action that the Disciplinary Committee of the institute deems fit.
Date*

DayMonthYear
Date
Signature of Applicant

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I_________Father/Guardian_________________________of Miss/Mrs.________________ Hereby declare that the above statement of particulars is true and that my daughter/ sister has applied for Community Midwifery Course with my consent.

I here also understand that my daughter/sister will abide the rules of school/hostel/hospital as contained in the prospectus of the institution, if she fails to do so at any stage will render herself liable for any action that the Principal of the institute deems fit according to provision of relevant rules.
Date*

DayMonthYear
Date
Signature of Father/Guardian

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Submission Checklist
* Please get your documents attested by the Head of School/College attended.
1- Attested Passport Size Photograph*

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2- Attested Copy of Matric Certificate *

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3- Attested Copy of F.Sc/FA Certificate (optional)

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4- Attested Copy of National Identity Card or B Form*

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5- Attested Copy of Father/Guardian’s National Identity Card*

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6- Attested Domicile Certificate.*

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7- Attested Certificate from a registered institution in case of being a Hafiz-e-Quran.

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Should be Empty:

PERSONAL DATA