Application Form for Authorisation and License as Health Personnel in Norway

Application Form for Authorisation and
License as Health Personnel in Norway
For SAK
Print the form and fill in all sections using capital letters
To:
Norwegian Registration Authority
For Health Personnel (SAK)
Postboks 8053, Dep
NO-0031 Oslo, Norway
Read the guidelines, print out the form and fill it in with capital letters, sign, and send the form by ordinary mail.
Personal Information
Surname/Family Name
Given Name(s)
Postal Address
Postal Code
Country
Citizenship
City
Sex
E-mail Address
Telephone
ID-Number
State Norwegian 11 digit ID number if available or temporary 11 digit IDNumber (D-number). If you do not have any D-number, state your date
of birth in fhe format DD.MM.YYYY
I hereby apply for (Tick 1 box only)
Authorisation
«Turnus»License
Health Personnel category:
Student License
Principal education / training
Description of education
Date of passing (DD.MM.YYYY)
List of enclosures (use p. 2 if needed)
Description of enclosure
Country of education
Encl. No.
Declaration and signature
1.
2.
3.
4.
5.
Place
I have read the guidelines for filling in the application form
The fee is prepaid.
All the documents required are enclosed, I am aware that insufficient documentation will delay the casehandling.
I hereby declare that all enclosed documents are copies of true documents. I am aware that forgery of documents is a punishable offence cf.
Norwegian Penal Act, Sect. 182, and that any such attempt will be reported to the police, to my employer and to the health authorities in my
home country.
I am aware that if I am granted authorisation or license, my name and particulars will be recorded in the Norwegian Register of Health Personnel.
Date
Signature
This page should only be filled in if there is a lack of space on page 1
List of enclosures (Cont. from p.1)
Description of enclosure
Encl. No.
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