Professional Letter Request Form Please type and provide all requested information Applicant Details First Name Middle Name Last Name Email Address Mobile Number Licensing Title DHCC License Number Clinical Operator Details Clinical Operator Name Phone Number Address Period of Employment From: To: Letters options (please select the appropriate letter) Primary Source Verification letter (PSV) Fees AED 500/- Certificate of Good Standing (CGS) Normal Fees AED 500/- Urgent Fees AED 1000/- License status Confirmation letter (LSC) - only for Doctors & Dentists applying for DHA license Fees AED 1000/- Notes: All letters are subject to additional AED 20/- knowledge and innovation fees. All paid fees are non-refundable You will be notified once your request is ready for collection not before 10 working days from submission date. Urgent Requests apply for CGS only ( to be collected within 2 working days after submission) Documents to include with your request form: Copy of the Passport Copy of the DHCC license Letter of employment, signed by an authorized person and stamped by the operator, stating Employee name, job title, Employment period and legal dispute against the employee in case of any For Inactive License: End of Service letter from the employer Fill change of status form Receipt of payment Declaration I hereby certify that the information provided above in this application, including all statements and documentation, are correct and true Also, during my license period at DHCC, NO disciplinary nor legal action has been taken against me concerning my competencies, professional conduct, abuse or misuse of chemical substance or drugs ______________________ ____________________ Signature Date Kindly submit the required documents along with this form either to the CPQ Reception or through this email, PLD@dhcr.gov.ae
Professional Letter Request Form Please type and provide all requested information Applicant Details First Name Middle Name Last Name Email Address Mobile Number Licensing Title DHCC License Number Clinical Operator Details Clinical Operator Name Phone Number Address Period of Employment From: To: Letters options (please select the appropriate letter) Primary Source Verification letter (PSV) Fees AED 500/- Certificate of Good Standing (CGS) Normal Fees AED 500/- Urgent Fees AED 1000/- License status Confirmation letter (LSC) - only for Doctors & Dentists applying for DHA license Fees AED 1000/- Notes: All letters are subject to additional AED 20/- knowledge and innovation fees. All paid fees are non-refundable You will be notified once your request is ready for collection not before 10 working days from submission date. Urgent Requests apply for CGS only ( to be collected within 2 working days after submission) Documents to include with your request form: Copy of the Passport Copy of the DHCC license Letter of employment, signed by an authorized person and stamped by the operator, stating Employee name, job title, Employment period and legal dispute against the employee in case of any For Inactive License: End of Service letter from the employer Fill change of status form Receipt of payment Declaration I hereby certify that the information provided above in this application, including all statements and documentation, are correct and true Also, during my license period at DHCC, NO disciplinary nor legal action has been taken against me concerning my competencies, professional conduct, abuse or misuse of chemical substance or drugs ______________________ ____________________ Signature Date Kindly submit the required documents along with this form either to the CPQ Reception or through this email, PLD@dhcr.gov.ae
Professional%20Letter%20Request%20Form.docx