Rs. 50/= HANDLING CHARGES · -Orthodontics-Operative Dentistry ... Designated branches of UBL in the country (list enclosed). orBank draft/Pay order payable in the name of CPSP. Postal

Rs. 50/= HANDLING CHARGES

Page -2

R-FCPS - II Remaining 2 (f.b@b@r) 181111

PRESENT STATUS(Tick Mark Appropriate Box)

Employed ❑

If employed:

Designation

Name of Institution

Address of Institution

Name of Immediate Supervising Officer

PRESENT MAILING ADDRESS (Residential Only)

Date of Birth

- -

DD MM YYYY

AREA CODE NO.

Martial Status Married ❑ Single ❑

Nationality Sex Male ❑ Female ❑

City Country

C.N.I.C

Tel. (Res.) AREA CODE NO.Office

CODE NO.Cell Email

PERMANENT ADDRESS (If different from above)

--

--

--

AREA CODE NO.Tel. (Res.) AREA CODE NO.Office --

--

City Country

No/Date Amount Bank Branch

EXAMINATION FEE

Challan United Bank Ltd.

Bank Draft

Pay Order


Page -3

DECLARATION

I, Dr.

S/o D/o W/o

do solemnly declare that all the information provided above is correct.

DD MM YYYY

DATE SIGNATURE OF CANDIDATE

INCOMPLETE APPLICATION WILL NOT BE PROCESSED

LIST OF DOCUMENTS REQUIRED TO BE ENCLOSED WITH THE APPLICATION FORM

1. Evidence of having paid examination fee (Original Challan UBL / Pay Order / Bank Draft)

2. Five coloured photographs (uncovered faces) taken recently and of prescribed size (5cm x 6 cm). One tobe pasted in the box on each form and got attested on front. Other photographs be stapled in the boxprovided in the application. These photographs should indicate name of candidate in capital letters andattested on the back.

3. Last Admit Card is to be returned with present application. The Admit Card for the present examinationwill be issued only when the last Admit Card has been returned. In case the admit card has been lost,penalty could be imposed.

4. All Repeater candidates have to submit a certificate of attendance of the required mandatory workshopsalong with application form for examination, If not submitted earlier.

5. Computerised National Identify Card.

6. Valid PMDC Registration Certificate.

7. In case the candidate is repeating the examination after a period of more than Three Calendar Years he/she shouldapply on the application form prescribed for “Fresh Candidates” and attach all the required documents again.

8. Any other relevent document which needs to be submitted with this application form (give details)

Coloured, recent & alike

Passport Size Photograph( 5 x 6 cm)

ATTESTEDon back

indicating name of candidate in

CAPITAL LETTERS& stapled



ATTESTEDon back





ATTESTEDon back





ATTESTEDon back




Page - 4

FOR OFFICE USE ONLY

DD MM YYYY

DATEReceipt No.

Processed by

Name

Checked by

Rechecked by


Page - 5

CHECK LIST FOR FRESH / REPEATER CANDIDATES (as applicable)

The eligibility of the candidate shall be determined on the basis of documents submitted with theapplication form which will be treated as final. Incomplete form will be rejected and nocorrespondence will be entertained after submission of application form.

Following are the documents required to process application form for FCPS-II examination. Pleasecheck (✔) the appropriate box ‘Yes’ or ‘No’. Explanation must be given on a separate page, if youhave checked (✔) ‘No’ to any of the documents.

1. Letter of passing FCPS-I (letter of congratulation) ❑ ❑

2. Certificate of passing Intermediate Module examination,

MCPS Diplima in the relevant for subject Fresh candidates. ❑ ❑

3. Certificate of residency training with complete detail of rotation as prescribed ❑ ❑

in the relevant prospectus. (On institution’s letter head signed by supervisor,

HOD and HOI with clearly mentioned dates of training, reference number, date of issue)

4. RTMC registration certificate for registered training ❑ ❑

5. Appointment order and joining report of training, including rotations ❑ ❑

6. Certificate of attendance of mandatory workshop (as applicable)

i. Introduction to Computer and Internet ❑ ❑ii. Research Methodology Biostatics and Dissertation (Irrespective of the approval of dissertation) ❑ ❑iii. Communication Skills ❑ ❑iv. Basic Surgical Skills (For candidates appearing in Surgery & Allied subjects) ❑ ❑

7. Computerized National Identity Card ❑ ❑

8. M.B.B.S / BDS. degree ❑ ❑

9. Valid PMDC registration certificate ❑ ❑

10. Five coloured recent & alike photographs (5cm X 6cm) One to be attested on front & seaming on the back. ❑ ❑

11. Evidence of having paid examination fee ❑ ❑

(original bank draft/pay order. Bank Challan “Amount, No. and Date” Postal order are not accepted)

12. Log Book prescribed by CPSP (as applicable) complete in all respect duly

signed by Supervisor and Clinical diary for Family Medicine candidates. ❑ ❑

13. Dissertation approval certificate or two accepted/ published articles as 1st or

second author in Index Journals with prior approval of synopsis of article by RTMC. ❑ ❑

14. Any other document which needs to be submitted with this application form

(give detials) ❑ ❑

Candidates must submit this sheet along with application form

Note: All the Photocopies must be attested. Attestation must be stamped with name anddesignation of the attester by one of the following.

● Fellow of CPSP with his Fellowship number ● Principal /Professor of Medical College/Postgraduate Medical Institute● Medical Superintendent/Head of the Medical Institution

YES NO.

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7th Central Street, D.H.A. Phase II,Karachi-75500 (Pakistan)Tel: 99207100-10Fax: 99207120, 35881444UAN: 111-606-606E-mail: [email protected]: www.cpsp.edu.pk

NNOOTTIIFFIICCAATTIIOONN FFOORR

OCTOBER 2012FCPS-II EXAMINATION

EXAMINATION DATE OF EXAM PAPER TIMING

FCPS-II All Subjects Except Followings October 09, 2012 Paper I 9.00 a.m To 12.00 noon(Medicine, Surgery, Paediatrics, Tuesday Paper II 2.00 p.m To 5.00 p.mObstetrics & Gynaecology andOphthalmology)

SCHEDULE OF EXAMINATION

SUBMISSION OF APPLICATION FOR FRESH AND REPEATERS

It is notified that OCTOBER 2012 FCPS-II theory examination will be held as under:1

2

● All applications must be received at CPSP Head office, Karachi, its Regional Offices on

or before the dates mentioned above. Delays in postal deliveries shall not be considered

a valid reason for the late receipt of application.

● Please note that above examination is not held outside Pakistan.

● For further correspondence, please note to mention your name, subject and

Examination centre from where you are appearing in the examination.

No. F.1-3/EXAM-2012/CPS/289B Dated: June 01, 2012

F/R. FCPS - II Remaining 1 (f.b@b@r) 181111

FRESH RES

● Application with prescribed fee upto JULY 5, 2012

● Application with Late Fee of Rs. 2000/=

(Non refundable) upto JULY 12, 2012

● Application can also be received with

additional Late Fee of Rs. 1000/= (Non refundable) upto JULY 19, 2012

● Last date for withdrawal of application

from examination upto August 17, 2012

●

● Last date for change of Centre / Subject

with fee of Rs. 1500/= (Non refundable) upto August 17, 2012

FRESH & REPEATERS

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RR EE FF UU NN DD OO FF FF EE EESeventy five percent of the examination fee shall be refunded to the candidate after deduction of 25%processing charges subject to:■ Application for withdrawal from the examination received on or before the specified date.■ Rejection of the application by CPSP on account of ineligibility.

In all other cases the fee paid for a particular examination will not be refunded or carried overto next examination in case of withdrawal after specified date, absence/exclusion from theexamination for any reason.

FF OO RR MM AA TT OO FF EE XX AA MM II NN AA TT II OO NN

4

FCPS PART-II■ ANAESTHESIOLOGY, CARDIO-THORACIC ANAESTHESIA ORTHOPAEDIC SURGERY & E.N.T., DIAGNOSTIC RADIOLOGY,

RHEUMATOLOGYPaper I 10 Short Answer Questions (SAQs)

Paper II 100 Multiple Choice Questions (MCQs)

■ BASIC SUBJECT (ANATOMY, BIOCHEMISTRY & PHYSIOLOGY)Paper I 10 Short Answer Questions (SAQs)

25 Multiple Choice Questions (MCQs)05 Short Answer Questions (SAQs)

■ ALL OTHER SUBJECTSPaper IPaper II

(Those candidates who qualify in theory will be eligible to take oral/ clinical/ practical examination.)

5

■ Anaesthesiology

■ Basic Subjects

- Anatomy- Biochemistry- Physiology

■ Cardiac Surgery

■ Cardio-Thoracic Anaesthesia

■ Cardiology

■ Community Medicine

■ Dermatology

■ Dentistry

- Oral & Maxillofacial Surgery- Orthodontics- Operative Dentistry- Prosthodontics

■ Diagnostic Radiology

■ Family Medicine

■ Forensic Medicine

■ Gastroenterology

■ Medical Oncology

■ Nephrology

■ Neurology

■ Neuro Surgery

■ Neonatal Paediatrics

■ Nuclear Medicine

■ Orthopaedic Surgery

■ Paediatric Cardiology

■ Paediatrics Surgery

■ Pathology

- Chemical Pathology- Clinical Haematology- Haematology- Histopathology- Immunology- Microbiology- Virology

■ Otorhinolaryngology (ENT)

■ Physical Medicine & Rehabilitation

■ Plastic Surgery

■ Pulmonology

■ Psychiatry

■ Rheumatology

■ Radio Therapy

■ Thoracic Surgery

■ Urology

■ Viterio-Retinal Ophthalmology

FCPS PART- II

SS UU BB JJ EE CC TT SS FF OO RR OO CC TT OO BB EE RR 22 00 11 22 EE XX AA MM II NN AA TT II OO NN6

(10 Short asnwer questions (SAQs) in each paper.}

NNOOTTIIFFIICCAATTIIOONN FFOORR FFCCPPSS--IIIIEEXXAAMMIINNAATTIIOONN OOCCTTOOBBEERR 22001122

EE XX AA MM II NN AA TT II OO NN FF EE EE FFCCPPSS--IIII -- RRSS 1155,,000000Examination fee, as mentioned above is to be deposited along with the application form on enclosedchallan form in:➊ United Bank Ltd., CPSP Booth, Karachi, Lahore, Peshawar.❷ Designated branches of UBL in the country (list enclosed).

oorr Bank draft/Pay order payable in the name of CPSP.Postal orders, money orders or Personal Cheques are not acceptable.

3

}Paper II


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AA PP PP LL II CC AA TT II OO NN FF OO RR MM SS

7th Central Street, Phase II, D.H.A., Karachi-75500 Tel. No. 99207100-10; Fax: 99207120, 35881444; UAN: 111-606-606; Web: www.cpsp.edu.pk

7

■ Each application must be accompanied with duly filled prescribed enrolment form (unlessalready submitted earlier).

■ Only, application forms issued for OCTOBER 2012 examination will be accepted.(Photocopies of the application form are not acceptable.)

✬ SEPARATE APPLICATION FORMS ARE TO BE USED BY FRESH ANDREPEATER APPLICANTS

NNOOTTIIFFIICCAATTIIOONN FFOORR FFCCPPSS--IIIIEEXXAAMMIINNAATTIIOONN OOCCTTOOBBEERR 22001122

Abbottabad 1st floor Admin Office, Ayub Medical Complex, Abbottabad. 0992-381907-14

Bahawalpur Quaid-e-Azam Medical College, Bahawalpur 0622-884768, 886794

Faisalabad Punjab Medical College, Faisalabad 041-9210131

Hyderabad Sir Cowasji Institute of Psychiartric, Hyderabad. 022-3860056-7

Islamabad CPSP Regional Office, Ravi Road, P.I.M.S., G-8/3, Islamabad 051-9261196, 9262590-1

Lahore CPSP Regional Office, Next to Inmol, Block-D, New Muslim Town, Lahore 042-99231320-5

Larkana Chandka Medical College, Larkana 0741-459369

Multan CPSP Regional Office District Jail Road, opp. Circuit House, Multan 061-9200946, 9200952

Muzaffar Abad Abbas Institute of Medical Sciences, Muzaffar Abad 43902 / 43307 (0300-8501636)

Nawabshah People Medical College, Nawabshah 0241-9370271, 9370249

Peshawar Hayatabad Medical Complex, Phase IV, Hayatabad, Peshawar 091-9217011, 9217320

Quetta CPSP Regional office, Cenar Hospital, off: Brewery Road Quetta 081-9203434, 9202424

Rawalpindi Armed Forces Institute of Cardiology, Rawalpindi 051-9271002 Ext. 3050

Application Forms are available on website of CPSP (www.cpsp.edu.pk) that can be downloaded andsubmitted at Head Office of the College of Physicians & Surgeons Pakistan, Karachi or its offices listedbelow. A sum of Rs. 50/- has to be added in the fee as handling charges.

VV EE NN UU EE OO FF EE XX AA MM II NN AA TT II OO NNTHEORYThe theory examinations are held simultaneously in eleven or more different cities of Pakistan. The candidateshave an option to choose one of these venues for appearing in the theory examination according to theirconvenience. The choice of the city should be clearly indicated in the appropriate box in the application form.However, CPSP reserves the right to delete a particular centre on the basis of logistic reasons.

ORAL / CLINICALSThe College can hold oral/practical/clinical examination in one or more cities of the country depending upon thenumber of candidates eligible to take this examination and logistic facilities available in that city irrespective ofthe venue at which a candidate appeared in theory examination. Exact Venue of Oral/Clinical/Practicalexamination will be communicated after the theory examination.

NOTE:Training must have been completed one month before the date of theory examination i.e.by September 09, 2012.

(DR. MUHAMMAD SHARIF)Chief Controller Examinations

8


Documents

Rs. 50/= HANDLING CHARGES · -Orthodontics-Operative Dentistry ... Designated branches of UBL in the country (list enclosed). orBank draft/Pay order payable in the name of CPSP. Postal