Personal Information |
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First Name: |
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Middle Initial: |
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Last Name: |
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Date of Birth |
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Nationality: |
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Place of Birth: |
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Age: |
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Sex: |
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Marital Status: |
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Telephone (home): |
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Telephone (work): |
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Postal Address (work): |
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Postal Address (home): |
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Name, Postal Address
& Telephone number of a local contact person: |
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Medical Degree, College/University Name, Date Degree Obtained: |
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List of Additional and/or Higher Qualifications with dates: |
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State type of practice you which to pursue |
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Professional References: Name 3 and state full postal address: |
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Have any proceedings ever been initiated against you in a court of law by a medical licensing authority? (if yes provide details) |
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Required Documents |
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| Applicants are advised to submit the following items once registration form is submitted. Be sure to include your name and contact information when submitting required documents: Click here to submit required documents |
* You are requested to upload an unmounted photograph of yourself (Any photo of recent date which provides a good likeness is sufficient) |
* Notarized Copies of the Medical Qualifications Documents (or original documents to be inspected by the Chairman or the Registrar) |
(Please note any Graduate of Universities considered to be an Off Shore Medical Schools are advised that copies of pass certificate in USLME 1& 2, The CAM-C exam, The MCCEE or the PLAB is required for registration.) |
* Detailed Curriculum Vitae (including Full Biographical Data, Medical Education and Post-Graduate Training, Post-Graduate Qualifications, Clinical Experience, Employment History and Research work) |
* Current Certificate of Good Standing issued by the relevant Medical Licensing Authority (original only) attesting as to whether or not the applicant has ever been subject to disciplinary enquiry |
* Document certifying citizenship status (e.g. copy of relevant parts of the passport) |
N.B. Non-Bahamian citizens cannot be registered without the concurrence of the Minister responsible for immigration.
If approved, Certificate of Registration and Licence will be issued upon payment of the prescribed fees, Five Hundred Dollars $500.00, ($100.00 registration and $400.00 licence).
FAILURE TO PROVIDE ALL THE ABOVE DOCUMENTS WILL RESULT IN REJECTION OF THE APPLICATION
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