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Request For Certification Letter

This document is a request form for an Oman Medical Specialty Board certification letter. It contains sections for the examinee to provide their personal details and reason for the request. It also confirms payment of administrative fees and agrees to pay any courier fees. Sections B and C are for the finance section and testing center to confirm payment receipt and certification letter details. Upon verification, the certification letter will be issued.

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Iman Azrbj
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109 views

Request For Certification Letter

This document is a request form for an Oman Medical Specialty Board certification letter. It contains sections for the examinee to provide their personal details and reason for the request. It also confirms payment of administrative fees and agrees to pay any courier fees. Sections B and C are for the finance section and testing center to confirm payment receipt and certification letter details. Upon verification, the certification letter will be issued.

Uploaded by

Iman Azrbj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Oman Medical Specialty Board ‫المجلس العُماني لالختصاصات الطبية‬

Request for Certification Letter

A. For Examinee:
 Full Name : …………………………..…..……..…….………......………….
 Exam Name : ……………………………………….………...………………..
 Exam Confirmation No.: ………………………………….…….…………………...…….
 Passport No. : …………………………….…….………………………...…….
 Date of Exam : ………………………….…………..………….…..…………….
 Authorized Person to Collect the letter (optional): ………………………...……………
I hereby agree to request a certification letter from OMSB as a replacement for my original
OMSB test score report for the following reason:
Lost/misplaced/misused, etc. Misspelling(s) Others ………………………..
I agree to pay administrative charges of 10 Omani Rial (OMR).
Method of payment: Cash Wire Transfer
I agree to pay UPS corrier fees if Certification Letter needs shipment.
*Please attach a passport photocopy with this request.
Signature of Examinee: ………………………………… Date: …………….………….……..

B. For Finance Section (OMSB):


We confirm that the payment has been received.
Date:……/………/………. Signature: ……………………… Stamp: ……………………….
Receipt No: ……………………………

C. For Prometric Testing Centre (OMSB):


We confirm that the examinee’s score details have been retrieved and verified. Upon this request,
the Certification Letter has been issued.
S/N of the Certification Letter: …………………………..
Date:……/………/………. Signature: ……………………… Stamp: ……………………….

Cc:
- Prometric Testing Centre
- Finance Section

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