Ukrainian Medical Council

Working as a doctor in Namibia

 

 

The Medical and Dental Council of Namibia requires that physicians seeking medical licensure/registration who completed their medical education outside Namibia submit copies ofcertain documents to the Educational Commission for Foreign Medical Graduates (ECFMG) International Credentials Services (EICS). EICS will obtain primary source verification of the authenticity of these documents from the entity that issued these documents to you.

 

The Medical and Dental Council of Namibia requires that you submit copies of the following

documents to EICS for verification:

• Medical school diploma

• Medical school transcript

• Postgraduate training certificates

• Medical licensure/registration certificates in other jurisdictions

 

Please complete the enclosed EICS Application for Verification of Credentials and send it to EICS with the required documents, passport-sized photographs and payment of US$150.00. Instructions for completing the application are included.

 

You will be notified when EICS has received and processed your completed application, documentation and fee. EICS will write to the issuing institutions listed on your application to secure primary source verification of your submitted credentials. EICS will send the institutions a copy of the document to be verified, an official EICS verification request form and a photograph signed by you to assist in identification. EICS will request that an authorized institution official complete and return the verification request form directly to EICS.

An EICS report will be issued to the Medical and Dental Council of Namibia upon receipt and processing of acceptable medical credential verification. The EICS report will contain your name and biographic information and list the medical credentials that have been verified and are still outstanding. Copies of all credentials and completed verification forms are included with the report. EICS will issue individual addendum reports to the Medical and Dental Council of Namibia upon subsequent receipt of additional verifications.

 

Your EICS application packet consists of the following items:

• Instructions for Completing the ECFMG International Credentials Services (EICS)

Application

• ECFMG International Credentials Services (EICS) Application

• Affidavit and Release

• Authorization for Release of Information, Documents and Records

• EICS Application Fee Payment SheetINSTRUCTIONS FOR COMPLETING THE EDUCATIONAL COMMISSION

 

FOR FOREIGN MEDICAL GRADUATES (ECFMG)

 

INTERNATIONAL CREDENTIALS SERVICES (EICS) APPLICATION

Please read these instructions carefully before completing the application for verification of credentials. Please type or print neatly in ink the information requested on the application. If you fail to submit all required information and documentation, processing of your application by the Educational Commission for Foreign Medical Graduates (ECFMG) International Credentials Services (EICS) shall be delayed.

 

Item 1 "Name”

Enter your full name as it appears on your Medical and Dental Council of Namibia application. 

Your last name (surname) and generational suffix must be on line 1.

Your first and middle name(s) must be on line 2.

Your maiden/alternate name(s) must be on line 3.

 

Item 2 “Gender”

Check the appropriate box.

 

 

Item 3 “Date and Place of Birth”

Enter your date of birth in the following order: 1) day, 2) month and 3) year. Include the country where you were born.

 

Item 4 “EICS or USMLE/ECFMG Identification Number”

Enter your EICS or USMLE/ECFMG Identification Number, if applicable.

If your medical credentials have been previously verified by EICS, it is not necessary to submit additional copies with your application. You must submit copies of credentials that were not included with your previous EICS application. Please remember to check the appropriate boxes on the EICS Application Fee Payment Sheet.

If your medical credentials have been previously verified by ECFMG, you must submit copies of all your medical credentials to EICS. EICS will review the documents and verification status of your ECFMG file. If your credentials have been previously verified by ECFMG (for USMLE/ECFMG exams or ECFMG certification) and are consistent with copies submitted with your application, EICS will accept the ECFMG verification in lieu of sending new verification requests to your medical school. Acceptance of ECFMG verification of credentials does not change the amount of your EICS application fee.

 

Item 5 “Contact Information”

Enter the complete mailing address that EICS will use in communicating with you in writing.

Include your telephone and fax numbers, and email address, if available.

 

Item 6 “Documentation”

Include with your application legible and complete original language copies of the following documents:

• Medical school diploma

• Medical school transcript

• Postgraduate training certificates

• Medical licensure/registration certificates

Please submit only one (1) copy of each medical credential.

Photocopy reduce oversized documents to 8½ x 11 inches (216 mm x 279 mm).

 

ENGLISH TRANSLATIONS

Any document not in English must be accompanied by an official word-for-word English language translation prepared and certified to be correct by a recognized translator or professional translation service. The translation must identify the translator and include the signature of the translator and, if appropriate, the official or representative of the translation

service.

VERIFICATION FEES

EICS may receive notification from an institution that a fee is required for completion of an EICS verification request. Payment of fees is the responsibility of the physician. EICS will notify you if a fee is required to obtain verification of your credentials.

 

Item 7 “Courier Service" (OPTIONAL)

EICS verification requests are sent via airmail and include a pre-paid international reply business envelope. To arrange for EICS to send your credential verification requests to their issuing institutions via courier service, check the appropriate boxes and include your courier service account number.

EICS does not accept credit card information for payment of courier shipment fees.

Confirm with your courier that the destination institution is within its service area.

EICS ships credential verification requests one-way. You will need to contact your institutions to arrange for courier service shipment back to EICS.

 

Item 8 “Medical School of Graduation”

Enter the full name, city, country, and attendance information for the medical school yougraduated from outside of Namibia. Include the full title of your degree.

If you attended more than one medical school, photocopy page 2 of the EICS application and use the photocopied page(s) as an attachment to the EICS application.

 

Item 9 “Postgraduate Medical Education”

Enter the full names, addresses and attendance dates for all the institutions where you completed postgraduate medical education outside of Namibia. This includes all internships, residencies and fellowships taken after graduation from medical school. Your specialty must be listed and Program box checked.If you completed postgraduate medical education at more than two institutions, photocopy page 3 of the EICS application and use the photocopied page(s) as an attachment to the EICS application.

 

Item 10 “Medical Licensure and Registration”

Enter the full names, addresses and licensure/registration dates for all jurisdictions where you held a license/registration to practice medicine outside of Namibia. Include permanent, limited and other special purpose licenses or registrations. Indicate the current status of each license/registration. If the license/registration was suspended or revoked, you must attach a separate sheet of paper and explain the reason.

If you obtained a license/registration to practice medicine in more than two jurisdictions, photocopy page 4 of the EICS application and use the photocopied page(s) as an attachment to the EICS application.

 

Affidavit and Release

Complete the Affidavit and Release by signing your name on the first line, printing your name on the second line and dating your signature on the third line. Attach one current, full-face photograph of yourself in the designated box. Have the Affidavit and Release certified by a notary public, first-class magistrate or consular official. Be sure the official dates and signs the document and lists his or her official title.

 

Applications submitted without completion of the Affidavit and Release by a

recognized official will have their processing delayed.

 

Authorization for Release of Information, Documents and Records

Complete the Authorization by signing your name and dating your signature on the first line, printing your name on the second line and listing your date of birth on the third line. Attach one current, full-face photograph of yourself in the designated box and then sign your name across the front of the photograph.

 

 

EICS Application Fee Payment Sheet

The EICS application fee for primary source verification of the medical diploma, medical school transcript, postgraduate training certificates and medical licensure/registration certificates is US$150.00. If you have previously submitted an application to EICS for processing, the application fee will be US$25. Include your EICS number on the payment sheet. Include your name, gender and birth date. Indicate whether a money order is enclosed or if the

fee should be charged to a credit card. For a credit card payment, indicate the type of card (Visa, MasterCard, Discover, or American Express), credit card number, expiration date and the address, name and signature of the card holder.

 

MAKE A PHOTOCOPY OF THE COMPLETED EICS APPLICATION FOR YOUR RECORDS.

RETURN THE EICS APPLICATION, COPIES OF YOUR MEDICAL CREDENTIALS AND

APPLICATION FEE TO THE ADDRESS BELOW:

 

Contact Information

Many answers to questions concerning EICS and the EICS application are available

through the EICS website (www.ecfmg.org/eics) or you may contact EICS at:

Email: ecfmgics@ecfmg.org

Phone: (215) 823-2274

Fax: (215) 966-3129

Street Address:

ECFMG/EICS

3624 Market Street

4th Floor

Philadelphia PA 19104

USA