Bank Chalan Form

All fields, marked with * are mendatory and must be filled.

This application is best used with I.E 10 or greater and latest versions of Google Chrome, Mozilla Firefox and Opera.

Type of Fee *
(Mark the right Fee Type)		 Renewal
Fresh
License Number
Licensee Name *
(Alphabets and Space only)
CNIC or NTN *
Licensing / Authorizations *
(Mark the right activity)		 License
NOC
Permit
Other Activity
(Specify if Applicable)
Type of Facility *
(Mark the right facility)		 Diagnostic X-Ray
Nuclear Medicine
Importer / Exporter
Industry
Research
Other Facility
(Specify if Applicable)
Business/Facility
Address
Amount (PKR) *
(Digits only)
In Rupees (Words)
Depositor Name
(Alphabets and Space only)
Mobile No. *
(Digits only)