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    Krishnammorthy KG Application Form

    Uploaded by

    Mohamed
    This document is an application for registration as an allied health professional with the Maldives Allied Health Council. It collects information such as the applicant's name, qualifications, supporting documents, employment, and includes declarations by both the applicant and employer. Registration is subject to providing all required documents and information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Krishnammorthy KG Application Form

    Uploaded by

    Mohamed
    14 views3 pages
    This document is an application for registration as an allied health professional with the Maldives Allied Health Council. It collects information such as the applicant's name, qualifications, supporting documents, employment, and includes declarations by both the applicant and employer. Registration is subject to providing all required documents and information.

    Copyright

    © © All Rights Reserved

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    This document is an application for registration as an allied health professional with the Maldives Allied Health Council. It collects information such as the applicant's name, qualifications, supporting documents, employment, and includes declarations by both the applicant and employer. Registration is subject to providing all required documents and information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views3 pages

    Krishnammorthy KG Application Form

    Uploaded by

    Mohamed
    This document is an application for registration as an allied health professional with the Maldives Allied Health Council. It collects information such as the applicant's name, qualifications, supporting documents, employment, and includes declarations by both the applicant and employer. Registration is subject to providing all required documents and information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    MAHC-F-R-V003

    MALDIVES ALLIED HEALTH COUNCIL


    MINISTRY OF HEALTH
    REPUBLIC OF MALDIVES Maldives Allied Health Council
    me/kw, - mduriney

    APPLICATION FOR ALLIED HEALTH PROFESSIONAL REGISTRATION

    Notice
    Please write clearly in filling this form
    Items 1-5 are completed by the applicant
    Items 6-8 are to befilled by the employer
    Registration is subject to receipt of all the documents in proper order.
    A non-refundablefee of MVR 150 is chargedfar processing registration Document no:
    Registration of Dhiyehibeysyerin and hithauni practioners use fbrin no. DBHF-2020-V01

    1. Type of mistration requested


    Requested Allied Health Professional Title Please refer to list of registered allied health professional titles
    New Registration: registered with the council. List is available from www.health.gov.mv. The application form will not be
    processed further if the requested professional title is not mentioned.

    Renewal of Registration: Fi MAHC Registration No. Issued Date: Expiry Date:

    /ARIA C IMLFbo20/21GG 01 - 20A1 -

    Reasons for late renewal if


    applying past the Expiry Date:

    2. Identification
    Full name (as shown in passport /
    Maldives National ID) kg 5 H NA M 00 R:T1-1 Y Kill\t/LEL CROP
    Passport no/ National ID No for
    Maldivians 5 5ooiss25
    Date of Birth
    26 - 0 9 --
    Nationality for Foreigners
    I NI M AIV
    Email for correspondence
    c.- r1SaNCA.r.roOcf-kNel \<,.%91 @,5,,,u,.1 .c.cr)
    Telephone No
    -41 /-1 5 416
    Address for correspondence in
    Maldives Cri D g • NVOD(*1 6-- I-1 -ke r- 1----r H cervieR
    Address for correspondence in home
    Country kt.IN hi e-L- rvciikinrvf./AN( pi vo ko-nrAyniki 6scz.56. ) KeRRLA- I

    3. Qualifications. Please state only allied health professional qualifications


    Name of Course Delivered Institute Awarded Institute Start date Date of award Recognizing body
    /Qualification

    5 P4N E 5 l'N/1 E- mot-\ ,a4e.%


    mpo,Acrymn G-0,INDHI AND4- )., oto • o1 s -
    ,B 5C MLT scry
    u rjivE i\

    Registration form MAHC-F-R-V002 /2020


    Page 1 of 3
    4. Supporting documents. Please tick as appropriate

    New Registration for Maldivian applicants.

    Tick DocUment

    Copy of National ID card


    Qualification certificate(s). Only certified copies of allied health professional qualifications relevant to requesting title need to be
    submitted. (Attested Copies)
    Mark sheet(s) for various semesters or years of the qualification. A consolidated transcript. (Attested Copies)
    Curriculum vitae
    Competency exam results for professions where Competency Exam is given.
    Recent passport size photo

    New Registration for foreign applicants.

    lick Document

    A certified copy of the relevant pages of your passport (the ones which show your date of birth, nationality and photograph).
    Evidence of any name change (e.g., deed poll, marriage certificate) if applicable.
    Qualification certificate(s). Only certified copies of allied health professional qualifications relevant to requesting title need to be
    submitted. (Attested Copies)
    Mark sheet(s) for various semesters or years of the qualification. A consolidated transcript. (Attested Copies)
    Curriculum vitae
    Professional Registration at other councils or other equivalent bodies, Professional Registration from private bodies or associations
    not recognized by. this council should not be submitted (Attested Copies)
    Competency exam results for professions where Competency Exam is given.
    Recent passport size photo

    Renewal of Registration Maldivian and Foreign applicants.

    Tick Document

    Copy of National ID card For Maldivian


    Passport copy for foreign applicants
    Previous Registration Copy
    Recent passport size photo

    IMPORTANT NOTES
    1. Documents in foreign languages other than English shall be submitted together with the certified English translations and original
    copies of the documents. The Maldives Allied Health Council will accept notarization by
    (i) the institute that issued the original certificate;
    (ii) any Embassy or Consulate of the country that issued the original certificate; and
    (iii) a government institute of the country that issued the original certificate.
    2. All documentation should be complete and the submitted documents should be clear and legible. The Allied Health Council will not
    accept illegible, unclear or incomplete applications and will not be responsible for delays that occur due to submission of illegible or
    incomplete documentation.
    3. The Maldives Allied Health Council may also require the Allied Health Professional to submit any other documents for evaluation of
    his/her application

    Registration form MAHC-F-R-V002 /2020


    Page 2 of 3
    5.Declaration by applicant
    I declare that al l information provided herein is true to the best of my knowledge and I understand that falsifying information
    would result in legal action, which may include but not limited to criminal prosecution.
    I will provide the Maldives Allied Health Council with any such further information as it may require and further authorizes the
    council to make queries as necessary
    • I do not have a mental or physical condition that renders me unable to perform the functions required for practice as an Allied
    Health Professional
    • I know of no information that could cause the Maldives Allied Health Council not to be satisfied that I am of good character and
    reputation and am a fit and proper person to be registered
    • I agree to adhere to the Standards of Conduct, Performance and Ethics and the Scope of Practice set by the Maldives Allied
    Health Council for the professional title under which i may be registered.
    I agree to inform to Maldives Allied Health Council any change to my email, telephone number and address for correspondence
    in Maldives.

    Name of the Applicant:AKR15.11.N.AM.O.ORTHY....Kei. Signature of applicant: .. 451


    1 —ctate. 7// 2 /2°9- I

    6. Current employment
    Name of Employer , 7

    M nth il A 4)1 14 Call-Fit


    Health Facility/ Work site
    (31 01-. mfrotto-i -rt,i- c_C2N'reg.
    Health Facility Registration No
    810 1
    Staff No
    bS1
    Position
    1-4toizePa2-31 'f:cci41•1o 1-o 67 i 5T-
    Date of Employment
    t 0'4' 114 4K-1-1 Ao 9,10
    Contract Expiry date
    -0.73
    r el

    04-riti 'Pi- g Fg (If 24/19-

    7. Declaration by Employer on current employment Information


    We confirm the authenticity of information contained herein about our organization a loyment status with us

    Of
    Employer. `I Mi.). ....... vahr Signature : ..... ..sta
    dret
    ...Dat /P14 01 1

    ./2

    8, Declaration by Employer for applicants renewing reg i tion


    We hereby declare that no disciplinary proceedings are in action against the applicant and that he/she has never been the subject of any inquiry.

    Employer. cyn5 Signature sta el/Ilk-91221

    Applications should be submitted to


    Maldives Allied Health Council,
    Ministry of Health,
    Roashanee Building, Sosun Magu, Male',
    Republic of Maldives
    Telephone: +960 3014480
    Email: mahc@health.clov.mv

    Registration form MAHC-F-R-V002 /2020


    Page 3 of 3

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