1. An application shall contain the following information:–
(a)the applicant’s full name, sex, date of birth and private address and telephone number;
(b)a full description of the applicant’s medical qualifications including the institution which awarded them;
(c)the applicant’s professional registration number and date of first registration in both registers;
(d)chronological details of the applicant’s professional experience (including the starting and finishing dates of each appointment together with explanation of any gaps between appointments) with any additional supporting particulars, and an explanation of why the applicant was dismissed from any post;
(e)in relation to the applicant’s professional experience provided under (d), the applicant shall separate that information into –
(i)general practice experience;
(ii)hospital appointments; and
(iii)other experience (including obstetric experience),
with full supporting particulars of that experience;
(f)details of any list or equivalent list from which the applicant has ever been disqualified, conditionally disqualified, removed or suspended or to which admission was refused together with reasons for disqualification, conditional disqualification, removal, suspension or refusal;
(g)name and addresses of two referees who are willing to provide clinical references relating to two recent posts as a medical practitioner which lasted at least 3 months without a significant break and which may include a current post, or, where this is not possible a full explanation and name and address of an alternative referee or referees;
(h)if the applicant is a national of an EEA state, evidence that the applicant has a knowledge of English which, in the interests of the applicant and of patients who may receive primary medical services from the applicant, is necessary for performing primary medical services;
(i)whether the applicant is a provider of primary medical services;
(j)if the applicant is a provider of primary medical services, whether the applicant is a provider under more than one arrangement, agreement or contract to provide primary medical services and, if so, details of the other arrangement(s), agreement(s) or contract(s);
(k)if the applicant is the director or one of the persons with control of a corporate body, the name and registered office of that body;
(l)whether the applicant is an armed forces GP;
(m)if the applicant is a GP Registrar, the name and address of the GP Trainer;