Medical Report Form - Registration Of Skilled Professional Act printable pdf download

Medical Report Form - Registration Of Skilled Professional Act

Photograph

Please attach a recent

passport-sized

photograph here for

each applicant.

MEDICAL REPORT FORM – REGISTRATION OF SKILLED PROFESSIONAL ACT (‘Act’) 2016

IMPORTANT NOTES

1. This medical certificate form must be completed in English by a Registered Medical Practitioner for

each person applying to stay in the Fiji for more than 6 months.

2. This certificate must be under 3 months old at the time of lodgment.

3. Each applicant must produce evidence of identification, such as passport, to the Medical Examiner.

4. Fees for the medical examination are payable by the applicant or their sponsor.

A. PERSONAL DETAILS OF THE APPLICANT

1. Name(s) as shown in the passport:

Surname:

Given Names:

2. Full residential address:

3. Gender: Male

Female

4. Date of Birth:

4. Passport number:

B. APPLICANT'S MEDICAL RECORDS

1. Has the applicant ever been hospitalized in the last 10 years or undergone surgery of any kind:

Yes

2. Has the applicant ever been refused employment, insurance, military service or entry to another

country on medical grounds:

Yes

Medical Report Form - Registration Of Skilled Professional Act