2. DECLARATION I declare that the foregoing particulars are correct and I hereby apply for admission to the Examination for the Licentiate in Dental Surgery (LDS) Signature Date Please refer to for details of the documents you must submit with ‘Application Guidance’ your application 3. CHARACTER REFERENCE DECLARATION OF REFEREE – This section should be completed by: or GMC registrant who has known the applicant for at least one year and is not a relative • A GDC OR person of similar standing from his/her own country who has known the applicant well for at • A least one year and is not a relative. The whole section is to be completed by the GDC or GMC registrant. I (Full name in BLOCK CAPITALS) Of (Please state full UK/overseas registered address) I certify that I have been well acquainted with (name of applicant) years, that he/she is the person he/she declares himself/herself to be and for that he/she is of good character. GDC/GMC Registration Number (if applicable) Position held Email address Mobile number The information that I have provided is complete, true and correct. Signed Date
2. DECLARATION I declare that the foregoing particulars are correct and I hereby apply for admission to the Examination for the Licentiate in Dental Surgery (LDS) Signature Date Please refer to ‘Application Guidance’ for details of the documents you must submit with your application 3. CHARACTER REFERENCE – DECLARATION OF REFEREE This section should be completed by: • A GDC or GMC registrant who has known the applicant for at least one year and is not a relative OR • A person of similar standing from his/her own country who has known the applicant well for at least one year and is not a relative. The whole section is to be completed by the GDC or GMC registrant. I (Full name in BLOCK CAPITALS) Of (Please state full UK/overseas registered address) I certify that I have been well acquainted with (name of applicant) for years, that he/she is the person he/she declares himself/herself to be and that he/she is of good character. GDC/GMC Registration Number (if applicable) Position held Email address Mobile number The information that I have provided is complete, true and correct. Signed Date