Part II Information to be contained in a statement of satisfactory completion of a period of prescribed experience in a post falling within regulation 8I1

Practitioner’s name and address

GMC Full Registration number

Dates between which training took place, and total duration of training in months

Whether training was full-time or part-time, and if part-time, what ratio to full-time

Name and practice address of hospital or community post

Number of hospital or community post or other reference, where available

Name of post and hospital grade, if appropriate.

Speciality of post.

Name, grade and professional address of doctor supervising training

Statement of satisfactory completion of training

Date of signatures required by regulation 9(5)(b)