NS |S
THE UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH COMMUNITY DEVELOPMENT,
GENDER, ELDERLY AND CHILDREN :
HEALTH LABORATORY PRACTITIONERS’ COUNCIL
PARTI
APPLICATION FOR COUNCIL'S EXAMINATIONS
FILL IN BLOCK LETTERS
a:
9.
Person particulars
(a) Sumame ...
(b) Other names.......
(©) Date of birth.....\/3
(d) Nationality...
(e) Present address in Tanzania
AOS er Po Bek 2092.
( Mobile umber... OT UMAR SE ae
(g) Email address......... NAAMEER @amai(s eee,
Registration status: provide eu Provisional Registration number
vee. £0624.
Employment status: Employed /Not employed (ltemployed provide the name and
address of the employer)
to
hoyedhs.....
Cee Mou, : “eet (Anuna)
ory) RMS
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