THE MEDICAL AND DENTAL COUNCIL, REPUBLIC OF THE GAMBIA APPLICATION FOR REGISTRATION IN THE REGISTERS FOR MEDICAL AND DENTAL PRACTITIONERSSurnameField is required!Field is required!Date of BirthField is required!Field is required!- select gender -MaleFemale- select gender -Field is required!Field is required!ForenameField is required!Field is required!- Nationality -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- Nationality -Field is required!Field is required!- Marital Status -Field is required!Field is required!Address:Postal addressField is required!Field is required!Your E-mail AddressField is required!Field is required!Residential AddressField is required!Field is required!- Your Phone number -Invalid phonenumber!Invalid phonenumber!Primary Qualification:DescriptionField is required!Field is required!Date ObtainedField is required!Field is required!Medical School / UniversityField is required!Field is required!Previous Registration(s):- select country -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- select country -Field is required!Field is required!Select a dateField is required!Field is required!Registering Body:Field is required!Field is required!Has any Council or similar body ever REFUSED registering you in any Register? - Select Option -YesNo- Select Option -Field is required!Field is required!- select country -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- select country -Field is required!Field is required![{"field":"{option}","logic":"equal","value":"refuse","and_method":"","field_and":"","logic_and":"","value_and":""}]Date of such refusal:Field is required!Field is required![{"field":"{option}","logic":"equal","value":"refuse","and_method":"","field_and":"","logic_and":"","value_and":""}]Reason(s) for refusal:...[{"field":"{option}","logic":"equal","value":"refuse","and_method":"","field_and":"","logic_and":"","value_and":""}]Field is required!Field is required!Professional Conduct:Has any Council or similar body SUSPENDED/ERASED your name from any of its REGISTERS? YES/NO- select a option -YesNo- select a option -Field is required!Field is required!- select country -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- select country -Field is required!Field is required![{"field":"{option_2}","logic":"equal","value":"yes","and_method":"","field_and":"","logic_and":"","value_and":""}]Date Suspended / Erased:Field is required!Field is required![{"field":"{option_2}","logic":"equal","value":"yes","and_method":"","field_and":"","logic_and":"","value_and":""}]Date RE-INSTATED:Field is required!Field is required![{"field":"{option_2}","logic":"equal","value":"yes","and_method":"","field_and":"","logic_and":"","value_and":""}]Reason(s) for SUSPENSION / ERASURE:[{"field":"{option_2}","logic":"equal","value":"yes","and_method":"","field_and":"","logic_and":"","value_and":""}]Field is required!Field is required!Has any Council or similar body ever investigated you for an alleged breach of professional conduct? YES/NO- select a option -YesNo- select a option -Field is required!Field is required!- select country -Åland IslandsAfghanistanAlbaniaAlgeriaAmerican Samoa (US)AndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermuda (UK)BhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurma (Myanmar)BurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook Islands (NZ)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (UK)Faroe Islands (Denmark)FijiFinlandFranceFrench GuianaFrench Polynesia (France)GabonGambiaGeorgiaGermanyGhanaGibraltar (UK)GreeceGreenland (Denmark)GrenadaGuam (US)GuatemalaGuernsey (UK)GuineaGuinea-BissauGuyanaHaitiHondurasHong Kong (China)HungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of Man (UK)IsraelItalyIvory CoastJamaicaJapanJersey (UK)JordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau (China)MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotte (France)MexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew Caledonia (France)New ZealandNicaraguaNigerNigeriaNiue (NZ)Norfolk Island (Australia)Northern Mariana Islands (US)NorwayOmanPakistanPalauPalestinian territoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn Islands (UK)PolandPortugalQatarRéunion (France)RomaniaRussian FederationRwandaSão Tomé and PríncipeSaint Helena, Ascension and Tristan da Cunha (UK)Saint Kitts and NevisSaint LuciaSaint Pierre and Miquelon (France)Saint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen (Norway)SwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelau (NZ)TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis and Futuna (France)Western SaharaYemenZambiaZimbabwe- select country -Field is required!Field is required![{"field":"{option_investi}","logic":"equal","value":"investigate","and_method":"","field_and":"","logic_and":"","value_and":""}]- select a option -CriticalHighMediumLow- select a option -Field is required!Field is required![{"field":"{option_investi}","logic":"equal","value":"investigate","and_method":"","field_and":"","logic_and":"","value_and":""}]Outcome:...[{"field":"{option_investi}","logic":"equal","value":"investigate","and_method":"","field_and":"","logic_and":"","value_and":""}]Field is required!Field is required!Present Employer:Employer NameField is required!Field is required!Address of EmployerField is required!Field is required!Date CommencedField is required!Field is required!Description/Position (i.e., Consultant, Registrar, MO, HO, etc.)Field is required!Field is required!Anticipated Place of WorkField is required!Field is required!Select a dateField is required!Field is required!Signature:Field is required!Field is required!Application Form must be accompanied by: (i) Photocopies of Certificates/Diplomas. If not in English, kindly attach a notarised translation. Council reserves the right to ask for Original Copies of any support documentation for verification purposes.(ii) A recent passport size photograph of the applicant.(iii) A Certificate of Good Standing/Professional Status from the last Country of Practice.<h3>Application Form must be accompanied by:</h3> <p>(i) Photocopies of Certificates/Diplomas. If not in English, kindly attach a notarised translation. Council reserves the right to ask for Original Copies of any support documentation for verification purposes.<br />(ii) A recent passport size photograph of the applicant.<br />(iii) A Certificate of Good Standing/Professional Status from the last Country of Practice.</p><h3>Application Form must be accompanied by:</h3> <p>(i) Photocopies of Certificates/Diplomas. If not in English, kindly attach a notarised translation. Council reserves the right to ask for Original Copies of any support documentation for verification purposes.<br />(ii) A recent passport size photograph of the applicant.<br />(iii) A Certificate of Good Standing/Professional Status from the last Country of Practice.</p>Field is required!Field is required!Photocopies of Certificates/Diplomas.Field is required!Field is required!Recent passport sizeField is required!Field is required!Certificate of Good Standing/Professional StatusField is required!Field is required!Submit
