Академический Документы
Профессиональный Документы
Культура Документы
3. Passport Information:
Passport No: __________________________ Expiry Date: ________________
National ID Card No. ____________________ Expiry Date: _________________
4. Contact Details:
Telephone (Home): ______________ Mobile: ______________ Fax: _________________
Mailing Address: ______________________________________________________________
E-mail: _______________________________________________________________________
In Case of Emergency, Person to contact:
Name: _______________________ Tel. No. (Home): ____________ (Mobile): __________
Relationship to Applicant:_______________________(E-mail): __________________________
5. Medical Education:
Institution Name: ________________________________ Country: ____________________
Date of Graduation: __________________
Language used in Medical College: English Arabic Others: __________
Internship: Completed Ongoing Institution: ________________________
Dates (From): _______________ to ______________
I authorize OMSB to conduct source verification of my MD credentials from the Institution
stated above
6. Previous OMSB Selection Exam/IFOM Clinical Science Examination (CSE):
Have you previously sat for the IFOM CSE Exam? Yes No
If yes, when and where? _________________________________________________________
Oman Medical Specialty Board المجلس العماني لالختصاصات الطبية
DECLARATION
I,_______________________________, hereby certify that I have attended ___________
/ /
_________________________ Medical School from Day Month Year and have graduated with
/ /
a Degree in Medicine on Day Month Year .
APPROVAL:
Approved
Not approved Reason: _________________________________________________