Medical Report Form - Registration Of Skilled Professional Act Page 3

SIGNATURE OF APPLICANT:

SIGNATURE OF EXAMINER AS WITNESS:

………………………………………………………..

………………………………………………………………

DATE: ………………………………………………

DATE: ……………………………………………………….

PART X: MEDICAL EXAMINER'S DECLARATION:

1. I have confirmed the identity of the applicant from his/her passport, identification papers and

appearance.

2. I am satisfied that the particulars submitted by the applicant are true and correct.

3. The statements made by me in answer to all questions in this form are true to the best of my

knowledge and belief.

4. I certify that the applicant is medically fit/not medically fit to reside and work in Fiji.

SIGNATURE OF MEDICAL EXAMINER:

…………………………………………………….

DATE: ………………………………

MEDICAL EXAMINER STAMP/SEAL:

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