Page 45 - Registrar Orientation Manual 2016

Completing yoapplication formSec on 1
Please check all details carefully and show the chancolumn provided.
Change of name
If you have changed your name the HPCAA requireus know this in wri ng within 1 month of the chanupdate the medical register.
Please send us a cer ed copy of any document whicyour change of name for example a marriage cer caO cers of the Court, Notaries Public, or Jus ces of thauthorised to cer fy photocopies of original documThe medical register will then be amended to reconame, and cross referenced to show your previousAt work, please use the name you are registered wconfusing to the public when a doctor prac ses undi erent to that recorded in the medical register, aregister will show that you are not registered to pryou have also registered under an alterna ve namChange of address
If you have changed your postal, residen al, or woHPCAA requires you to tell us of this in wri ng. Plespace provided for changes. Your name may be remthe medical register if we cannot contact you.
If you would like your registered address to remainplease put this request in wri ng, addressed to theSec on 2
This sec on con rms your prac sing inten ons. If prac sing you do not need to apply for a prac sing