Declaration of fitness to practise - Revalidation

We need an up-to-date declaration of your fitness to practise before we can make a decision on your revalidation.

You are asked to declare either 'yes' or 'no' in response to the following question:

'I confirm I am not aware of any proceedings, act or omission on my part which might render me liable to be referred to the GMC for investigation or consideration of my fitness to practise.'

If you answer 'no' to the question above, you must provide full details of the issue(s).

You do not need to repeat any issues previously reported to us. Your declaration should therefore only relate to the period since you last made a declaration to us - for example, as part of your most recent annual return.

Any false declarations may result in withdrawal of your registration and licence to practise.

You should answer 'no' (and provide full details) if any of the situations below apply to you.

If there is a situation that is not covered here and you think it may be relevant, include these details as well.

Situation	Additional Information
If you have been convicted of an offence in a court of law or been cautioned, either in the UK or another country. You must include: any convictions in the UK that have been spent under the Rehabilitation of Offenders Act 1974 any road traffic convictions any offences for which you have been convicted in a military court or tribunal details of any Anti-Social Behaviour Order (ASBO) you have been given.	If you have been cautioned, or convicted in a court of law, you must tell us: the date of the caution or conviction the name and address of the court or police authority and the details of the penalty (if applicable) that was imposed you will need to supply evidence of the caution or conviction in the form of a caution note or conviction notice, or a recent Criminal Records Bureau report. Please note, you do not need to supply documentary evidence of any road traffic offences where you have accepted the option of paying a fixed penalty notice, but you will need to provide us with brief details of the offence(s) and confirmation that the offence(s) were dealt with via the issuing of a fixed penalty notice
You have, at any time, been issued with a fixed penalty notice either in the UK or another country. If you have, tell us if you contested the notice.	You may be asked for: documentary evidence of the penalty or harassment notice received. Please note, you do not need to supply documentary evidence of any road traffic offences where you have accepted the option of paying a fixed penalty notice, but you will need to provide us with brief details of the offence(s) and confirmation that the offence(s) were dealt with via the issuing of a fixed penalty notice.
You have, at any time, been suspended from duty, or had a complaint upheld or your registration or licence to practise removed while working as a medical practitioner, or health or social care professional in the UK or another country.	You must provide us with: the name of the organisation/employer involved in your suspension from duty a full statement from you regarding the matter, including the nature of the sanction and length of time it was imposed details of the nature of the complaint and a named person to contact for further information.
You have, at any time, been fined, given a warning or reprimanded by any medical, health, social care or any other regulator in the UK or another country.	You must provide us with: details of the regulator that imposed the sanction, including your reference/registration number any documentary evidence you have of the sanction/warning imposed a full statement from you detailing the background and grounds of the sanction/warning, and detailing any appeals that were made against the sanction/warning.
Having read our guidance on fitness to practise and health matters, is there something you need to tell us about your physical or mental health?	We might ask you for further information about your health. In some cases, we might ask for more information from a third party (for example, information from an occupational health physician).
You are aware of an aspect of your conduct and/or capability that might raise a question about your fitness to practise as a doctor in the UK	You may be asked to provide a full statement detailing the nature of the current or past issue and how it may impair your current fitness to practise or raise a question about your fitness to practise.
A medical school or university has, at any time, taken some form of disciplinary action and/or fitness to practise procedures against you.	You must provide us with: a full statement detailing the nature of the allegation, the disciplinary action taken and any other information you may wish us to consider in relation to the incident(s) any documentary evidence you have, relating to the disciplinary action undertaken by your medical school contact names and contact details (address, email and telephone number) of person(s) involved at the medical school, that we can approach to secure further information and details.
An employer has, at any time, taken disciplinary action against you.	You must provide us with: a full statement on the nature of the action taken against you and any other information you would wish us to consider any documentary evidence you have, relating to the disciplinary action undertaken by your employer(s) contact names and contact details (address, email and telephone number) of person(s) involved at the employing organisation that we can approach to secure further information and details.
You know of a reason why the medical regulatory authority in any of the countries where you have worked since qualifying as a doctor, would refuse to grant you a Certificate of Good Standing.	You must provide us with details of: the name of the medical regulatory authority that will not issue the Certificate of Good Standing in any country where you have worked, or held registration or a licence your registration details with that authority a full statement from you on the reason you have not been able to obtain the Certificate(s) of Good Standing.
You are aware of any current or future proceedings or other matters that might lead to your registration or licence to practise in any country being removed, suspended or restricted in some way.	You must provide us with a full statement and any documentary information you have, relating to the current or future proceedings and: the names of the regulating or employing bodies and/or persons involved in the matter(s) the contact names and contact details (address, email and telephone number) of person(s) involved in the proceedings/action, who we can approach to obtain further information and details any other information that you would like us to consider, with regards to the proceedings pending.