Registration Application Form
To be completed in duplicate by applicant himself/herself (one electronically and 2 physical copies to the office of the Council)
Please upload relevant and cleared documents to the specified uploaded fields. Failure to provide the correct/clear documentation and/or completed form shall result in your submission not being considered, and you will be required to complete the registration process again.
Applicant Information
Full Name of Applicant
*
First Name
Middle Name
Last Name
Permanent Address
*
Current Address - Same as Permanent
*
Yes
Other
Current Mailing Address - Same as Permanent
*
Yes
Other
Gender assigned at birth
*
Female
Male
Other
Marital Status
*
Telephone Numbers
*
Email Address
*
example@example.com
Place of Birth
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Citizenship(s)
*
Language Spoken by Applicant - First
*
Language Spoken by Applicant - Other(s)
*
Medical Qualifications and Referees
Primary Medical Degree
*
Country where degree was obtained
*
Date Medical Degree obtained
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
For Primary Medical Degree
University Awarding Degree
*
Higher medical qualifications (specialty) / degree(s)
*
Reasons for requesting registration in Belize
*
Name and address for two professional referees whom the applicant has worked with in the last two years. Both letters of reference from said referees must have been written in the last six months. Letters must be addressed to the Medical Council of Belize, stamped and delivered sealed along with hard copies of application and other documents. Electronic version should be uploaded below apart from the physical ones delivered.
Professional Referee 1 - Name and Address
*
Letter 1 from Professional Referee
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Professional Referee 2 - Name and Address
*
Letter 2 from Professional Referee
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Registration Checklists
Which Status Matches you?
*
Belizean / Caricom National Applicant
Non-Caricom National Applicant (Includes new applicants and those currently with Temporary Registration)
Application for Recognition of Higher Qualification (Fully Registered Medical Practitioners)
Authenticated degree, diploma or certificate
*
Must be authenticated with the seal and signature of (1) Dean of the University, (2) Ministry of Education of Belize, (3) Ministry of Foreign Affairs of Belize and (4) the Belize Embassy or British High Commissioner, or the Apostile where applicable.
Upload Authenticated original degree, diploma, or certificate
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Sealed Official Transcript
*
Sealed official transcript from all Institutions of Medical Education (Must be received sealed with hard copies of application documents)
Letter of Good Standing / Certificate of Current Professional Status
*
Letter of Good Standing from the Medical Council equivalent of last country of practice. (Medical regulatory authority that verifies active licenses, confirms current registration, license validity, disciplinary record and personal details.)
Upload Current Letter of Good Standing
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
License to Practice
*
Current Licenses to practice.
Upload All Valid Licenses
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Notarized Translated Document(s)
*
Notarized translation to English language performed by a certified translator, if the documents are in any other language.
Upload Notarized translated document
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Caricom Citizenship Document(s)
*
Proof of Caricom Citizenship (birth certificate, passport).
Upload Caricom Citizenship document(s)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
2 Notarized Passport Pictures
*
Two notarized recent passport size photographs.
Upload 2 recent notarized passport size photographs
*
Browse Files
Drag and drop files here
Choose a file
Please ensure that when submitting photographs, the back of each photo is endorsed with the following certification statement by a Notary Public or Justice of the Peace (JP):"I, (Notary Public/Justice of the Peace), certify that this is a true likeness of (name of individual on photo)."Photographs that do not contain this certification shall be considered incomplete and will not be processed.
Cancel
of
Police Record(s)
*
Police Record from place of residence from each place of residence of 6 months or more.
Police Record(s)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Receipt
*
Submission of Application form must be accompanied by receipt of having paid $100.00 application fee to the account of the MEDICAL COUNCIL OF BELIZE with the Heritage Bank Ltd., Account no: 9141455
Upload receipt of $100.00
*
Browse Files
Drag and drop files here
Choose a file
Heritage Bank Ltd. Acct. number: 9141455: Medical Council of Belize
Cancel
of
All Documents Ready for Delivery
*
Application form and all documents must be submitted electronically and physically in Duplicate to the office of the Medical Council of Belize at 1216 Blue Marlin Boulevard, Belize City, Belize. (Check this box when you have all required documents in a manilla folder ready for delivery)
Firm Accepted Offer of Employment
*
Firm accepted offer of employment from local healthcare institution; endorsed by both parties and detailing Terms of Employment (Job Details - job title, daily tasks, work hours, location. Pay and Benefits- Starting salary or hourly wage, payment schedule, paid time-off. Policies- rules on attendance, conduct, and safety. Termination- notice periods, severance rules and grounds for dismissal)
Upload Accepted offer of Employment
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Publications of Job Opportunity
*
Three publications advertising said post must accompany application form.
Upload 3 publications (newspaper or online publications)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Signature and Application Date
Applicant Signature
*
Submit
Submit
Should be Empty: