1. No category

Application Form for Authorisation and
Licence as Health Worker in Norway
For SAK
Print the form and fill in all sections using capital letters
To:
Norwegian Registration Authority
For Health Workers (SAK)
Postboks 8053, Dep
NO-0031 Oslo, Norway
Personal Information
Surname/family name
Given name(s)
Postal address
Postal Code
Country
Citizenship
E-mail address
Gender
Telephone
ID-number
State Norwegian 11 digit ID number if available or temporary 11 digit IDNumber (D-number). If you do not have any D-number, state your date
of birth in fhe format DD.MM.YYYY
I hereby apply for: (Tick 1 box only)
Authorisation
Internship License
Student License
City
Health Worker category:
Other License
Principal education / training
Description of education
Date of graduation
(DD.MM.YYYY)
List of enclosures /attachments
Description of enclosures
Country where educated
Encl. No.
Declaration and signature
1.
2.
3.
4.
Place
The fee is paid.
All the documents required are enclosed. I am aware that insufficient documentation will delay the case handling.
I hereby declare that all the enclosed documents are copies of the original documents. I am aware that forgery of documents is a punishable
offence cf. Norwegian Penal Act, Sect. 182, and that any such attempt will be reported to the police, to my employer and to the health authorities
in my home country.
I am aware that if I am granted authorisation or license, my name and particulars will be recorded in the Norwegian Register of Health Workers.
Date
Signature
List of enclosures/attachments (contd. from p.1)
Description of enclosure
Encl. No.