Postcode Contact telephone no: Email address: Do you wish your earnings to be superannuable? Yes NI number – No Is the above address your registered GMC address: Yes No* *If no, please state your registered GMC address: Postcode Date of last appraisal / / I attach my last appraisal to this form. Proposed date of next revalidation with the GMC, if / / New or current post/working details: Please tick as appropriate: New Practice details GP Performer Practice name and address: Salaried GP by Practice Salaried GP by CCG GP Registrar Practice code: Retainer Returner Start date: Locum If you intend to work as a locum in which area(s) do you intend to do the majority of your locum – work? Previous post/working details: Please tick as appropriate: Last practice details GP Performer Practice name:
Postcode Contact telephone no: Email address: Do you wish your earnings to be superannuable? Yes – NI number No Is the above address your registered GMC address: Yes No* *If no, please state your registered GMC address: Postcode Date of last appraisal / / I attach my last appraisal to this form. Proposed date of next revalidation with the GMC, if / / New or current post/working details: Please tick as appropriate: New Practice details GP Performer Practice name and address: Practice code: Start date: Salaried GP by Practice Salaried GP by CCG GP Registrar Retainer Returner Locum If you intend to work as a locum – in which area(s) do you intend to do the majority of your locum work? Previous post/working details: Please tick as appropriate: Last practice details GP Performer Practice name:
npl2-movement-form.docx