Application Form for the Part 2 FRCOphth Oral Examination – Singapore
Tuesday 01 – Friday 04 March 2016
Candidate Number:
Last name of candidate:
Other names in full:
Full postal address:
Telephone Number: Home
Email Address:
Work
Date of Birth:
Medical Qualifications with dates:
University or Medical College:
Country of Qualification:
GMC Number (if applicable):
If you are registered or anticipate being registered with the GMC then your personal data, including data
about your examination results, will be passed to the GMC for quality assurance and research purposes and
to facilitate the awarding of certificates of completion of training (CCT).
Have you at any time had (or do you have pending) any investigations, suspensions, limitations or removal
of medical registration in any country? (If yes, please provide details)
If you have sat this examination on a previous occasion please state the number of times you have sat this
examination: ____________
Date of Passing Part 2 FRCOphth Written Examination (after 1 September 2014)
I would like to request additional arrangements and include the required supplementary evidence 
There is no specific training requirement to enter this examination but candidates are unlikely to
successfully complete this examination without a significant period of training in ophthalmology.
Candidates in Ophthalmic Specialist Training:
Candidates who are in ophthalmic specialist training (OST) are asked to confirm their deanery and current year of
training. Please be aware that details of your result will be forwarded to your Training Programme Director.
Year of Commencing OST:
Current Year of OST:
Please select your Deanery:
Tick
East Midlands (North)
East Midlands (South)
East of England
Kent, Surrey and Sussex
London (NW & NE Thames &
Moorfields)
Mersey
Northern
Tick
North Western
Oxford
Severn Institute
South West Peninsula
South Yorkshire & South
Humberside
Wessex Institute
West Midlands
Tick
Yorkshire
Northern Ireland
Wales
East of Scotland
North of Scotland
South of Scotland
West of Scotland
Please ensure your application complies with College Regulations. The closing date for applications is Tuesday 5th
January 2016 at 5pm.
The fee for sitting the Part 2 FRCOphth Oral Component is £2000.00. Please make cheques payable to ‘The Royal
College of Ophthalmologists’. Alternatively, Visa and MasterCard are accepted. If you wish to use this method of
payment, please complete your details below.
This application form must be returned to the Examinations Department, The Royal College of Ophthalmologists, 18
Stephenson Way, London, NW1 2HD, together with the fee and documentation.
Please note it is not possible to accept application forms after the closing date for receipt of applications.
Applicants are advised to send applications forms by Special Delivery or Recorded Post to guarantee delivery.
There will be a maximum number of 30 examination spaces available for the March 2016 Oral Component.

I hereby apply to be admitted to the Part 2 Fellowship Oral Examination at National University of Singapore
(NUS) Yong Loo Lin School of Medicine from 01 to 04 March 2016 and enclose the fee of £2000.00
Signature of Candidate:
Date of Application:
Details for Card Payment (this section is detached and destroyed once payment is processed)
Name of Cardholder:
Card Number:
Expiry Date:
Security Code (CSV):
Start Date:
Issue Number:
Monitoring of Equal Opportunities
The Council of The Royal College of Ophthalmologists would be grateful, although it is not compulsory, if
you would help the College to monitor equal opportunities within its Examinations by answering the
following questions and submitting the completed form with your Examination Application. The ethnic
groups used are those recommended by the Equality and Human Rights Commission.
NAME OF EXAMINATION CANDIDATE: ………………………………………………
GENDER OF EXAMINATION CANDIDATE:
□
MALE
□
FEMALE
ETHNIC BACKGROUND OF EXAMINATION CANDIDATE:
Please choose one selection from (a) to (h) then tick the appropriate box to indicate your cultural
background:
a)
□
□
□
□
□
□
White
British
English
Scottish
Welsh
Irish
Any other white background, please specify…………………………………
b)
□
□
□
□
Mixed
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background, please specify………………………………...
c)
□
□
□
□
Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
Indian
Pakistani
Bangladeshi
Any other Asian background, please specify…………………………………
d)
□
□
□
Black, Black British, Black English, Black Scottish or Black Welsh
Caribbean
African
Any other Black background, please specify…………………………
e)
□
□
Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh
Chinese
Any other Chinese background, please specify…………………………
f)
□
Other ethnic group
Other, please specify………………………………………………
□
Decline to Answer
Do you consider yourself to have a disability according to the terms given in the Disability Discrimination
Act 1995 (DDA)?
□ Yes
□ No
FIRST SPOKEN LANGUAGE OF EXAMINATION CANDIDATE: ……………………