PROVISIONAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

Name of Applicant:

Date of Application:

Address of Applicant:

Tel. No:

Email Address:

Nationality:

Date of Birth of Applicant:

Sex:

Male Female

Qualifications of Applicant:

Country:

Where (University) Qualification Obtained:

Signature:

Your Signature:

NOTE

Confirmation Letter of success in final MBBS/MD Examination
Certificate of Selection for Approved Post from UHWI of MOH
Names and addresses of two (2) medical referees (to be written on the back of the form);
Passport size photograph (1)
Fees (J$2,000.00

PROVISIONAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

Name of Applicant:

Date of Application:

Address of Applicant:

Tel. No:

Email Address:

Nationality:

Date of Birth of Applicant:

Sex:

Male Female

Qualifications of Applicant:

Country:

Where (University) Qualification Obtained:

Signature:

Your Signature:

NOTE

Confirmation Letter of success in final MBBS/MD Examination
Certificate of Selection for Approved Post from UHWI of MOH
Names and addresses of two (2) medical referees (to be written on the back of the form);
Passport size photograph (1)
Fees (J$2,000.00

SPECIAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

Name of Applicant:

Date of Application:

Address of Applicant:

Tel. No:

Email Address:

Nationality:

Date of Birth of Applicant:

Sex:

Male Female

Qualifications of Applicant:

Country:

Where (University) Qualification Obtained:

Signature:

Your Signature:

NOTE

Certified Photostat or certified copies of academic certificates or diplomas;
Certificate of Registration or Licence;
Certificate of Good Standing with registering body or valid Licence;
Names and addresses of two (2) medical referees to be written on the back of the form);
Passport size photograph (1)
Fees Short Term Volunteers (1 day to 3 Months) $1,000.00
Fees 3 months and over ($1,000.00 - $11,000.00) depending of year of graduation

NB: If returning then items 3, 6/7 with completed application form

FULL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

Name of Applicant:

Date of Application:

Address of Applicant:

Tel. No:

Email Address:

Nationality:

Date of Birth of Applicant:

Sex:

Male Female

Qualifications of Applicant:

Country:

Where (University) Qualification Obtained:

Signature:

Your Signature:

NOTE

Full Registration - Original Degree Certificate
Certified Photostat or certified copies of academic certificates or diplomas;
Certificate of Registration or Licence;
Certificate of Good Standing with registering body or valid Licence;
Names and addresses of two (2) medical referees (to be written on the back of the form);
Passport size photograph (1)
Fees ($6,000.00 - $11,000.00) depending of year of graduation

Dr. Winston De La Haye

PROVISIONAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

NOTE

PROVISIONAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

NOTE

SPECIAL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

NOTE

FULL REGISTRATION

FORM A

THE MEDICAL ACT, 1976

APPLICATION FOR REGISTRATION AS A MEDICAL PRACTITIONER

To the Medical Council of Jamaica

NOTE