SURRENDER VETBOARD REGISTRATION
Complete this form to voluntarily surrender your registration with the Veterinary Practitioners Registration Board of Victoria.
Your Victorian registration number
*
Name
*
First/given name
Last/family name
First/given name
Middle name
Last/family name
Email
*
Mobile telephone
*
Eg, 0491 570 110
Required date of removal (latest 30 June of current practising year)
*
-
Day
-
Month
Year
Date
Reason for request
Relocated to another jurisdiction
Not working as a veterinary practitioner
Retired from the veterinary profession
Other
Free field to add another request or ask a question
Select the following items to proceed with removal request
*
I wish to surrender my registration with the Veterinary Practitioners Registration Board of Victoria on the date requested above.
I understand that I cannot practise as a veterinary practitioner in Australia if I am not registered as a veterinary practitioner in Victoria or another Australian State or Territory.
Confirm removal request by writing your full name
First/given name + Middle name(s) + Last/family name
Submit removal request
Should be Empty: