36A
216
22nd May.]
[A.D. 1931.
I hereby declare that the above particulars are in
every respect complete and true.
Signature of Applicant .......
Signature of Witness..
Address of Witness
Date....
† Name and Address of Referee as to Character.
† Names and Addresses of Referees as to Charac-
ter, Training and Professional efficiency.
(1)
(2)
† One of whom shall be a person not being a relative of the applicant, who has known her personally for not less than three years, and the others shall be persons such as matrons of hospitals, registered medical practitioners, or other responsible persons under whom the applicant has worked.
(NOTE.-The Forms for application for admission to other parts of the Register will be similar to the foregoing form, muitatis mutandis.)
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