CN8

Form for applying for a review

Before you submit your application please

You should use this form if you have previously made an unsuccessful make sure you have read the following
application for entry onto the Specialist Register or GP Register with a sections of our website:
Certificate of Eligibility for Specialist Registration (CESR) or a Certificate
• Reviews and appeals
of Eligibility for GP Registration (CEGPR) and want us to reconsider this
decision: • Guidance on how to apply for a review

• based on evidence not yet seen • Specialty specific guidance

Or • Verification of your evidence

• because you consider a procedural error has been made

Please bear in mind that you must request a review within 12

months of the date of your decision letter.

This is a fillable PDF. You may type into the sections where we require answers.

To see the levels of information we share with different parties, please see our privacy policy at www.gmc-uk.org/privacy/

Fees

Please enclose the correct fee with your application. You can find more information about fees on our website
(www.gmc-uk.org/doctors/fees/index.asp).

If, after you have submitted your application and paid your fee:

• you withdraw your application, or

• it is unsuccessful, or
• we close it because you have failed, within the timescales we have given you, to:
• respond to our requests for evidence, or
• attend at an identity check if your application is approved,

we may deduct a fee from your refund.

For full details of our current fees please see our fees page (www.gmc-uk.org/fees).

Please send your completed application along with all the required documentation to:
General Medical Council, Specialist Applications Team, 3 Hardman Street, Manchester M3 3AW.
1 - Your personal details

GMC reference number Date of birth dd mm yyyy

Full name

2 - Your original application

Application ID Date of decision letter dd mm yyyy

Specialty

3 - Your review application

Please tell us why you are applying for a review.

I am applying for a review based on evidence not yet seen

I am applying for a review because I consider a procedural error has been made

4 - Your contact details

Full address

Postcode Country

Home telephone Work telephone Mobile telephone

Email address

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form. Page 2 of 17
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK)
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

5 – Your recent professional experience

Please provide details of any posts you have held since your previous application.

Start date Finish Current Name and Country Engaged Grade/title Specialty Employment Hours Supervisor Supervisor
date location of in Medical of Post Type of Name Post Title
hospitals where Practice clinical
you have practice
worked or per
details for when week
you were not
engaged in
clinical practice

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 3 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6 - Evidence submitted in support of your application

Please refer to your decision letter and College evaluation form if you have one. Look for the heading Further required
training, assessment and examination to see what recommendation is listed for you.
In this section of the form, you must state the recommendation you would like us to review. Please state the period of
training that was recommended and the fields it covers. And state the documentation that was recommended that you need
to supply to demonstrate the required standard.
If you are applying for a review based on additional evidence, please complete section 6a. If you are applying for a review
because you consider a procedural error has been made, please complete section 6b.
Please list the additional documents you wish to submit and also explain in the comments box how you consider that you
now meet the required standard, and, in the case of procedural error, where that error has occurred.
If you have any comments that you do not consider relate to a specific recommendation, you can state these in the
additional comments section.

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 4 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6a - Additional evidence

Recommendation 1
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (please state how you consider you have fulfilled the recommendation)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 5 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6a - Additional evidence

Recommendation 2
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (please state how you consider you have fulfilled the recommendation)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 6 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6a - Additional evidence

Recommendation 3
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (please state how you consider you have fulfilled the recommendation)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 7 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6a - Additional evidence

Recommendation 4
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (please state how you consider you have fulfilled the recommendation)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 8 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6a - Additional evidence

Additional comments
Please state below any additional comments that you you do not consider to relate to a specific recommendation

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 9 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6b - Procedural error

Recommendation 1
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (state how you consider you have fulfilled the recommendation and where a procedural error has occurred)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 10 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6b - Procedural error

Recommendation 2
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (state how you consider you have fulfilled the recommendation and where a procedural error has occurred)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 11 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6b - Procedural error

Recommendation 3
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (state how you consider you have fulfilled the recommendation and where a procedural error has occurred)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 12 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

6b - Procedural error

Recommendation 4
Please insert below the recommendation as written in the evaluation form or in your decision letter

Period of additional training (if any) and fields to be covered by it

Documentation, examination, assessment or other test of competency to satisfactorily demonstrate the standard required

Please list the additional documentary evidence you have included below

Comments (state how you consider you have fulfilled the recommendation and where a procedural error has occurred)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 13 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

Section 7 – Verifiers
All your evidence, other than qualifications you’re getting authenticated must be accompanied by a proforma signed by the
person who is attesting to the validity and accuracy of your evidence (your verifier). It’s very important that you read
an explanation of how to do this in our important notice about evidence. Please provide the details of your
verifiers below.

1 First verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

2 Second verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 14 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

Section 7 – Verifiers (continued)

Please provide the details of your verifiers below.

3 Third verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

4 Fourth verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 15 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

Section 7 – Verifiers (continued)

Please provide the details of your verifiers below.

5 Fifth verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

6 Sixth verifier

GMC reference number

Title (Dr, Mr, Mrs, etc)

Family name or surname

First name

Post title

Specialty

Institution or hospital

Postal address (including

city, postcode and country)

Work email address

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 16 of 17
You may type into all the areas of this form where we require information
All dates must be written in the format dd/mm/yyyy

8 – Final Declaration
I agree to:

1. the General Medical Council (GMC) making any other enquiries it considers appropriate to establish my fitness to
practise
2. the GMC, their representatives, and any other agent that the GMC shall from ask to carry out the checks on its
behalf, making any necessary checks to verify the information I have given
3. enquiries being made before and while I am register, including enquiries overseas which may involve the transfer of
my personal data outside the European Economic Area
4. the recipient of any enquiries providing the information requested
5. my personal data being given to my referees, government bodies and other third parties as may be reasonably
necessary.

The information I provide in my application is correct and true.

I understand that if I make a false declaration, or provided false information or provided false documents to support my
application the GMC may withhold or remove my registration and licence to practise and report the matter to the police.

I understand that to protect the public, the GMC may share my registration and licensing information with UK and
international regulators and law enforcement organisations.

I understand that if my application is granted my name will be entered onto the Specialist Register or the GP Register as
appropriate.

I have read Good medical practice and understand my actions may be judged against the standards and principles it
contains.

I have in place, or will have in place, at the point at which I practise in the UK, insurance or indemnity arrangements
appropriate to the areas of my practice.

I confirm I agree with the statements in the Final Declaration

9 - Your signature

Please sign and date below to confirm all of the above declarations

Signature

Date dd mm yyyy

10 - Checklist

Please make sure you include the following documentation with your application:

1. Current curriculum vitae (please see www.gmc-uk.org/doctors/cct_cv.asp for guidance)

2. Any additional documentary evidence you wish to submit in support of your application

3. Proformas to verify your evidence (It’s very important that you read an explanation of how to do this in our
important notice about evidence)

4. A cheque for the fee (www.gmc-uk.org/doctors/fees/index.asp)

This form was last updated on 01 November 2018.

Please make sure that you are using the most up-to-date version of the form.
Telephone us on 0161 923 6602 (or +44 161 923 6602 if calling from outside the UK) Page 17 of 17