Application Form for Authorisation and License as Health Personnel in Norway

Print the form and fill in all sections using capital letters To: Norwegian Registration Authority For Health Personnel (SAK) Postboks 8053, Dep NO-0031 Oslo, Norway

For SAK

Read the guidelines, print out the form and fill it in with capital letters, sign, and send the form by ordinary mail.

Personal Information Surname/Family Name Postal Address Country E-mail Address ID-Number

Given Name(s) Postal Code Citizenship City Sex Telephone

State Norwegian 11 digit ID number if available or temporary 11 digit IDNumber (D-number). If you do not have any D-number, state your date of birth in fhe format DD.MM.YYYY

I hereby apply for (Tick 1 box only) Authorisation TurnusLicense Student License Principal education / training Description of education

Health Personnel category:

Date of passing (DD.MM.YYYY)

Country of education

List of enclosures (use p. 2 if needed) Description of enclosure

Encl. No.

Declaration and signature

1. 2. 3. 4. I have read the guidelines for filling in the application form The fee is prepaid. All the documents required are enclosed, I am aware that insufficient documentation will delay the casehandling. I hereby declare that all enclosed documents are copies of true documents. I am aware that forgery of documents is a punishable offence cf. Norwegian Penal Act, Sect. 182, and that any such attempt will be reported to the police, to my employer and to the health authorities in my home country. I am aware that if I am granted authorisation or license, my name and particulars will be recorded in the Norwegian Register of Health Personnel.

5.

Place

Date

Signature

This page should only be filled in if there is a lack of space on page 1 List of enclosures (Cont. from p.1) Description of enclosure

Encl. No.