National Performers Lists Application Form Page 10
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32SECTION 3: Professional Details
25. Professional council
registration number (eg
GMC/GDC/GOC)
26. Date of first registration
(DD/MM/YYYY)
27. Date of full registration
(DD/MM/YYYY)
27(a). Doctors and OMPs only
Date of inclusion in GP register
(non-registrars)
(DD/MM/YYYY)
Yes
No
28(a). Do you have a licence to
practise?
(GPs and ophthalmic medical
practitioners only)
If you answered “no” to the above question please provide details and a supporting
explanation
29. Please give details of your
professional indemnity/Insurance
at a level commensurate with the
performers list application
30. OMPs only: OQC number
NPL1 Application Form v2 final
Page 10 of 32
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