APPLICATION FORM FOR PART 1 OF THE PLAB TEST 

Once you apply to sit a PLAB examination, the information you provide will be used to update, administer and maintain your record, process complaints, compile statistics, and send you relevant material. We supply data to the Department of Health, professional, educational and training bodies so that they can correct their own information and compile statistics. 

PLEASE COMPLETE THIS FORM IN CAPITAL LETTERS

PLEASE NOTE INCOMPLETE FORMS WILL DELAY ALLOCATION TO A TEST DATE

Please read Advice to Candidates carefully before completing this form. This can be accessed from the website (www.gmc-uk.org) or by phoning the GMC enquiry line on 020 7915 3630, or email plab@gmc-uk.org. 

GMC Reference Number (if known):

												

Have you made a previous application for PLAB?					
	Yes		No			
					
Personal Details						

Family Name:

First Name:

Other Names:

Title:

                               Day   Month   Year
Date of Birth:

Sex:

Nationality 1st:

Nationality 2nd:

First language:

Address:

Telephone:

Mobile:

Email:

Qualifications	

Primary Medical Qualification (eg: MB BS, MB ChB):

University or conferring body:    
                                         
Date on which you passed your final exams: 

Date Primary Medical Qualification awarded:

Country of qualification:

Language of instruction:                   

Other qualifications:

Title:                           Field of Medicine:                               Date awarded: 

Title:                           Field of Medicine:                               Date awarded: 

Information about Ethnic Origin	

We are committed to eliminating bias and promoting equality of opportunity, irrespective of race or ethnic background. We regularly review the ethnic background of all PLAB test candidates to make sure we are as free from bias as possible. 

This information will not be given to examiners but will be used to monitor the PLAB test. It will be treated confidentially and will be published only in a form that does not allow individuals to be identified. You do not have to complete this section but you will be providing us with vital information if you do so. 

Please tick the appropriate box below to indicate the ethnic group to which you belong. The list of categories has been drawn up in consultation with the Commission for Racial Equality.

[   ] Bangladeshi                                                                 [   ] Indian

[   ] Black African                                                                [   ] Irish

[   ] Black Caribbean                                                           [   ] Pakistani

[   ] Black Other (please specify)                                       [   ] White

…………………………………….                                          [   ] Other (please specify)

[   ] Chinese                                                                          ……………………………………..

	

IELTS results	

Please complete your IELTS results

         Listening          Reading                Writing              Speaking         Overall Band

Date of IELTS examination ________________________________________

I would like to take Part 1 of the test on one of the dates specified below:

1 (Date) ………………………………. (Venue) ……………………………..

2 (Date) ………………………………. (Venue) …………………………….

3 (Date) ……………………………….. (Venue) ……………………………

NB: Please ensure you put three different dates. If you do not your application may be delayed.

I hereby declare that:

•	The information given in this application is true and accurate.

•	I understand that if a test admission letter is sent to me, I will be charged a cancellation fee if I decide to postpone or cancel my test place. 

Please check that the information above is correct. Your original documents (primary medical qualification and IELTS scores) will be checked when you apply for limited registration. If you have given false information, you may not be granted registration even if you have passed the PLAB test. 

...........................................................	.................................………………
Signature of applicant	Date

If you wish to take the examination in the UK:

Send this form, and the fee of £145 (payable to the General Medical Council by cheque or sterling banker’s draft, money order or postal order) to: The Registration Directorate, General Medical Council, 178 Great Portland Street, London W1W 5JE

For those wishing to take the examination outside the UK:

Send this form and the fee of £145 (payable to the General Medical Council by cheque or sterling banker’s draft or money order) to the appropriate British Council office (see Advice to Candidates).