Medical Council of Malawi

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MEDICAL PRACTITIONERS AND DENTISTS ACT, 1987

MEDICAL PRACTITIONERS AND DENTISTS

(REGISTRATION AND MISCELLANEOUS FEES)

REGULATIONS, 1988

Statutory Declaration

I, …………………………………………………………..do solemnly and sincerely declare as follows:

THAT I am the holder of the following degrees, diplomas or certificates granted to me after examination by a University, College, Medical or Dental School or other examination authority, and that the courses of study in the professional subjects with respect to which the degrees, diplomas or certificates which I hold were granted covered the following periods-:

University, College, Medical or dental school or other institution	Period		Degree/Diploma or Certificate	Examining Authority
	From	To	Degree/Diploma or Certificate	Examining Authority
1.
2.
3.

THAT I have completed the following additional courses of training and had the following experience in the practice of my profession, namely:-

Description of Training or Experience	Period
Description of Training or Experience	From	To

THAT I would, so fart as professional qualifications are concerned, be entitled to practice my profession in the Country, state or territory in which my professional qualifications were granted.

THAT

I have never been debarred from practicing my profession on the grounds of professional misconduct;
My name has never been removed from any register or members of my professional misconduct; the laws of any country or state in which I have practiced my profession; and
No inquiry is pending which may result in an action being taken which is referred to in subparagraph (a) or (b).

AND I make this solemn declaration conscientiously believing the same to be true.

Signature

DECLARED at

this

day of

Signature of Attesting Authority

Capacity of Attesting Authority (e.g. Notary Public, Commissioner for Oaths, etc)

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