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(Please use BLOCK CAPITALS throughout this form) Please use the space provided to confirm any PRN / PIN numbers you have previously been issued:
All applicants who apply to become registered nurses with the NMC must demonstrate competence in the English language by achieving a specific mark in the International English Language Testing system (IELTS). Applicants must complete the academic version of the IELTS test and achieve an overall average score of 7 (out of possible 9). For more details on this mandatory requirement please refer to www.nmc-uk.org. If you have not met this standard please do not send this request to the NMC until you have done so. I tick to confirm I have met the above standard:
IELTS test report form number: ________________________________
Nationality: F I L I
Title Miss / Mrs / Mr / Ms / Other (Delete as appropriate) Please state Date of Birth: D D M M Last Name: First Names: Present Address: Y Y Y Y
c/o Liz Miller 4/F Dorland House, 20 Regent Street. London SW1Y 4PH
Country of Registration: P H I L I P P I N E S
I wish to apply for admission to the part of the Register of the Nursing and Midwifery Council (NMC) on: (Please X appropriate box) Part 1 Registered Adult Nursing X Part 3 Registered Mental Nurse Part 5 Registered Nurse for the Mentally Handicapped Part 8 Registered Sick Children’s Nurse Part 10 Registered Midwife Signature: ______________________
To complete this form, download it to your computer, fill it in and save it, then e-mail as an attachment to mailto:email@example.com. PLEASE DO NOT SEND ANY FEE TO THE NMC AT THIS STAGE.