Malaysian Universities Conjoint Committee of Ophthalmology

Registration Request Form - Create a New Account

Please fill-in your the form below and click the Submit button

HomeRegistration

Fill-in this form if you are applying for entry into

Medical Officer in Eye Department OR
Formal Training Program OR
Logbook for NSR Application OR
Sub-specialty Training Program OR
Maintenance of Professional Logbook OR
as a Supervisor

Approved registration will allow you to have your own login account for you to manage your own logbook record online. You may also submit your logbook online to your registered supervisor. If you are already registered under NOTeD, please sign in first before applying for the above entry.

Create Login

Email Address* :

Note: Email notification will be sent to this registered email address.

Personal Details

Photo :

Select PhotoChange Remove Note:
i) Passport sized photo must be in jpg / jpeg / png format only.
ii) Photo file name can't contain any of the following character: \ / ∶ ∗ ? " < > ∣ '

Full Name* :

MyKad* :

Passport* :

Medical Council Registration No :

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Current year APC No. :

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Date of birth* :

Gender* :

Male

Female

Address for correspondence :

Telephone No* :

(eg: 03-98765432)

Mobile No :

(eg: 0198765432)

Purpose of Submission

This submission is for the following purpose* :

Medical Officer in Eye Department

Formal Training Program

Logbook for NSR Application

Sub-specialty Training Program

Maintenance of Professional Logbook

Include as Supervisor

Category of Ophthalmology Training* :

Master (Ophthalmology)

FRCOphth

Others

If others, please specify :

Date Passed BSE* :

Estimated Day

Date of Gazettement* :

NSR No. :

Date of Basic Post Graduate Qualification* :

Estimated Day

Date of Admission :

Estimated Day

University / Institution* :

System* :

In Campus

Out Campus

Floaters

Others, please specify :

Professional Qualifications

						Add
No.	Qualification Type	Specify qualification (e.g: Bachelor of Medicine, MBBS, MD, etc)	University / Institution	Year of Graduation	Certificate (Upload certificate in PDF Format only. PDF file name can't contain any of the following character: \ / ∶ ∗ ? " < > ∣ ').

Posting

Note: Kindly specify your postings since housemanship

						Add
No.	University / Institution	Date From	Date To	Supervisor's Full Name (1)	Supervisor's Full Name (2)

Payment

A Registration Fee of RM 200 applies for this registration.

Payment made to :

Account name: COLLEGE OF OPHTHALMOLOGISTS, ACADEMY OF MEDICINE OF MALAYSIA
Account number: Current account (753-300-010-3)
Bank: UOB Bank (UNITED OVERSEAS BANK)

Payment method* :

Online bank transfer: RM 200

ATM bank transfer: RM 200

Upload copy of Payment Slip* :

Remove Select file Change

Note:
i) Upload copy of payment slip in PDF Format only.
ii) PDF file name can't contain any of the following character: \ / ∶ ∗ ? " < > ∣ '

Declaration

Type the number you see on the image* :