PLAB1

PLAB Part 1
application form

Before submitting this application

please see the following pages on

You should use this application form if:

0

You want to apply to take Part 1 of the PLAB

test and are unable to book a place online

our website at www.gmc-uk.org:

0

Before

you

Guidance

Apply

for

in

the

PLAB

test

candidates

International
Graduates

Medical
-

important

information

Please state below why are you unable to book

a place online:
The information you give on this
form will be used by the GMC to:
0

Process your application

Process complaints

Compile
statistics
undertake research

Send you GMC guidance

and other information.

and

Please write clearly in black ink and use capital letters

You do not need to provide documents with this application form. They will be checked at a
later stage.

You must complete all sections of this form marked with a *. If the form is incomplete it may be
returned to you.
Fee
Please enclose the correct fee of 230 with your application. If you hold refugee status please see our website
(www.gmc-uk.org) or contact us for the appropriate fee.

Posting your application form

Please post your completed application to:

General Medical Council, PLAB test section, 3 Hardman Street, Manchester M3 3AW

Your personal details

(If you do not have a GMC reference number, we will allocate you
one when
we receive your
application.)

GMC reference number

Family name or surname*
First name*
Other names
Date of birth*

D D M M Y

Y Y Y

Gender*

Your contact details

Full address*

Postcode*

Country*

Home
telephone*

Work telephone

Mobile telephone

Email

Your nationality and passport

details
Nationality*
Passport number
City or town of issue
Date of issue

Country of issue

D D M M Y

Y Y Y

Date of expiry

D D M M Y Y Y Y

Refugee status
(If you hold Refugee status in the UK please tick one option below)

Holders of a British passport cannot claim refugee status.

I am a refugee doctor and enclose an original letter from the Home Office as evidence of my status in
the UK stating that I have been given one of the following:
a)

Refugee status and I am recognised as a refugee under the 1951 UN convention

b)

Indefinite leave to remain in the UK (with refugee status)

c)

Indefinite leave to enter (with refugee status)

d)

Exceptional leave to remain in the UK (granted prior to 1 April 2003)

e)

Humanitarian leave to remain (Also known as humanitarian protection. Granted on or after 1

April 2003)

f)

Discretionary leave to remain (With no restrictions on working, granted on or after 1 April

2003)

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

Page 2 of 7

English language declaration*

(Please tick one option below.)

a)

I have passed the academic version of the International English Language Testing System
(IELTS)
(Please provide details below)

Test date

DD/MM/YYYY

Test report form number

Academic
Academic
Speaking
Overall
Reading
Writing
I am a new graduate and obtained my primary medical qualification (PMQ) from a university
where the
language of instruction and examination is English.
Listening

b)

c)

d)

I am not a new graduate and obtained my PMQ from a university where the language of
instruction and
examination is English and have practised continuously for the two years immediately
preceding this
application in a country where the language of professional practice is English.
I have passed an English language test for the purposes of obtaining registration with one of
the medical
regulatory authorities indicated on your website and I have continuously practised in that
country for the
two years immediately preceding this application.

You must provide evidence to prove your English language declaration. Please see our website (www.gmc-uk.org) for more information.

Your primary medical qualification

(In most cases your primary medical qualification is your first medical degree.)

Full title of your primary Name and full address (including

country) of the university (and
medical qualification*
college
if appropriate) that awarded your
qualification*

Date training

Date training

Date

started*

finished*

qualification
awarded

DD/MM/YYY
Y

DD/MM/YYYY

Further information about your primary medical

qualification *
PMQ
Have you studied for your primary medical qualification at any medical school other
1
than the one
that awarded the qualification?

(If yes please provide details below.)

Other medical schools you have attended

PMQ
2

Date training
started

DD/MM/YYY
Y

YES/NO
Date training
finished

DD/MM/YYY
Y

DD/MM/YYY
Y

DD/MM/YYY
Y

DD/MM/YYY
Y

DD/MM/YYY

DD/MM/YYY

Has any part of your primary medical qualification been undertaken by

remote or
distance
learning? (eg a period of study undertaken solely by internet or through
correspondence-based
learning)

YES/NO

(If yes please provide details on a separate sheet.)

PMQ
3

Is your primary medical qualification acceptable for the purpose of registration in the
country that
awarded your qualification? (eg subject to internship, further training or examination)
(If no please provide details on a separate sheet.)

PLAB test place*

YES/NO

Indicate below the dates and venue(s) that you would like to sit the PLAB test

1.

Date

D D M M Y Y Y Y

Venu
e

2.

Date

D D M M Y Y Y Y

Venu
e

3.

Date

D D M M Y Y Y Y

Venu
e

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

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Irish

White and Black African

Indian

Pakistani

Bangladeshi

Chinese

African

British (English/Welsh/Scottish/Northern Irish)

Gypsy or Irish Traveller
Any other white background (please write in)

White and Black Caribbean

White and Asian
Any other mixed background (please write in)

Any other Asian background (please write in)

Caribbean
Any other black background (please write in)

Arab
Any other ethnic group (please write in)

Prefer not to say

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

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Your diversity details

The GMC is committed to treating everyone fairly and meeting our legal responsibilities under the
Equality Act 2010 and related legislation (such as the Human Rights Act 1998). One of the ways we do
this is by asking people to provide information about their ethnicity, disability, gender, sexual
orientation, religion and beliefs.
Giving us this information is optional. If you choose to give it to us, we will keep it confidential and hold it
securely in line with data protection and other relevant legislation. We will use the information you give us
to analyse and report on statistical trends in medical education and practice in the UK. We will
anonymise/pseudonymise any data we publish so you cant be identified.
The information may be used by different teams at the GMC. We may also share your personal data with
other parties if required by law, where ordered by a court, or where it is otherwise in the public interest
(for example for research purposes). Where possible, data will be anonymised or pseudonymised before
we share it with any other party.
This information will not be shared with teams that make a decision about your application or your fitness to
practise.
Help with categories
Ethnicity
'White British' includes the categories of White English, White Welsh, White Scottish and White
Northern Irish. Disability
The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which
has a substantial and long-term (i.e. has lasted or is expected to last at least 12 months) and adverse
effect on the persons ability to carry out normal day-to-day activities.
Religion and belief
The list of categories includes all the options from the census 2011 for England, Northern Ireland, Wales and
Scotland.

Ethnic origin
White

British (English/Welsh/Scottish/Northern Irish)

Gypsy or Irish Traveller

Any other white background (please write in)

Irish

White and Black African

Mixed

White and Black Caribbean

White and Asian

Any other mixed background (please write in)

Asian or Asian British

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background (please write in)

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the
form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

Page 5 of 7

Black or Black British

Caribbean

Any other black background (please write in)

African

Other ethnic group

Arab

Any other ethnic group (please write in)

Prefer not to say

Prefer not to say

Religion and belief

No religion

Christian - Other

Buddhist

Christian - Presbyterian

Christian - Baptist

Christian - Protestant

Christian - Brethren

Hindu

Christian Catholic

Jewish

Christian - Church of England

Muslim

Christian - Church of Ireland

Sikh

Christian - Church of Scotland

Other

Christian - Free Presbyterian

Prefer not to say

Christian - Methodist

Sexual orientation

Bisexual

Other

Heterosexual/straight

Prefer not to say

Lesbian/Gay

Disability

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

Page 6 of 7

No disability or long-term illness

Learning disability - e.g. dyslexia

Disabled but prefer not to give details

Mental illness e.g. depression

Blind or sight loss

Speech impairment

Deaf or hearing loss

Cognitive disability - e.g. brain injury, autism

Mobility - e.g. difficulty walking short distances

or
climbing stairs

Other impairment - e.g. epilepsy, asthma,

cancer or
facial disfigurement

Manual dexterity

Prefer not to say

Final Declaration*
I confirm that the information I have provided in this application is correct and true.
I understand that any false declaration in any part of this application or false information or documentation
provided in support of this application may result in the GMC withholding or removing my registration, even if I
have passed the test.

I confirm that I have read and understood the Guidance for PLAB test candidates on your website.
I understand I may be charged a cancellation fee if I decide to cancel or change my test place.
I understand that a decision about the acceptability of the qualification will not be made until the GMC have
received an application for registration. The criteria for acceptability change from time to time and that
means that I could take the PLAB test but find that my qualification is not acceptable for the purposes of
registration. Full details of the current criteria can be found on the GMC website.
I understand that by presenting to sit the PLAB Part 1 exam I declare myself fit to sit the exam.
I will be required to produce evidence of my identity when I attend for Part 1 or 2 of the PLAB test. This must
be in the form of my passport, or United Kingdom Immigration and Nationality Department Identification
Document, or a home office travel document, or a United Kingdom driving license. The evidence must bear
my photograph.
My photograph will be taken when I attend for Part 2 of the PLAB test for future verification of my identity.
My personal data, including my photograph, and any of the information I provide to the GMC may be:
0

disclosed to Government agencies, employers, overseas regulators (including outside the EEA)
and other third parties where required by our procedures, by law or as may be reasonably
necessary
used by the GMC, their representatives, and any other agent that the GMC ask to carry out checks
on its behalf, to make any necessary checks to verify the information I have given, including checks
on my English language proficiency, employment, qualifications and the accuracy of any information
provided
used by the GMC and its partners for research purposes

Signature*
Date*

This form was last updated in June 2015. Please make sure that you are using the most up-to-date version of the form.
To obtain a current form telephone us on 0161 923 6602 (or +44 (0) 161 923 6602 if calling from outside the UK).

Page 7 of 7