GDC OreDentist Application AS05ORED635L

Your application and supporting documents should be returned to:
Examinations Team
General Dental Council
1 Colmore Square
Birmingham B4 6AJ
Overseas Registration Exam

Application
Dentists holding dental degrees from outside the UK and EEA
Application ORE DENTIST
Name Ms Asiel Hasen Shembeish
Date of Birth 05/07/1996
Application Reference AS05ORED635L
Section 1: Checklist
Please put a tick below against the documents that you are supplying with your application.
Remember, all copies must be certified. Please do not send your original passport. If any documents are not supplied your
application will be returned to you.
Application form Character reference Clinical experience reference(s)
Certified copy of passport One passport photo Original NARIC statement/certificate

(must also include signature page)
Original Certificate of Good Standing Certified copy of degree certificate
Original translation of documents (if applicable) Medical certificate (if applicable)
Evidence of name change (if applicable) Evidence of English language
Original academic IELTS test report form
Please note if your application is incomplete it will be returned to you.
gdc-uk.org 1 Online Application: Version 4.4 (Sept 2021)

Your application and supporting documents should be returned to:
Examinations Team
General Dental Council
1 Colmore Square
Birmingham B4 6AJ
Section 2: Declaration AS05ORED635L
I confirm that the details I have provided online and within this application are true and correct.
I understand that the GDC may contact my character referee and any of the health practitioners whose names have been provided.
I have read the GDC exam rules and regulations and Student Fitness to Practise document and confirm that I understand them and will
abide by them. I understand that making an application on the basis of false or fraudulent information, may result in my application being
refused and may result in other action being taken against me (including fitness to practise proceedings).
If you have not supplied a medical certificate with this application, please specify in the space below any adjustments arising from additional
needs that you may require during an exam. It remains your responsibility to notify the exams team of any subsequent additional needs or
changes to those declared below that may arise. You must do this at least five weeks before an exam sitting. The exam centres cannot
guarantee any adjustment but will consider it and advise you accordingly.
Your signature must match that on your passport. You must sign the form before requesting a character reference.
Signature Date
Please note if your application is incomplete it will be returned to you.

Dentist Overseas Registration Exam Application
Section 3: Primary dental qualification
University/college
Country of qualification
Title of qualification
Awarding body
Year started
Year completed
Year degree awarded
In order to process your application we need certified copies of the following documents. Please refer to the guidance
notes for a list of people who can certify documents.
i. Certified documents
• A copy of your primary dental degree certificate (a provisional degree certificate will not be accepted)
• A copy of your passport (this must show your name, photo, date of birth and signature and must be
signed and dated on each page by the person certifying the copy of the passport)
• Passport photograph (if the photo is not a true likeness to that on your passport, it needs to be certified
on the back by a professional e.g. your referee, or verified by a GDC registrant)
• Marriage certificate (a marriage certificate or other relevant legal documentation must be provided if
your name on any of your supporting documents is different to the name in which you are applying)
ii. Original documentation

• The following documentation must be originals. We will return these documents to you once your
application has been processed.
• NARIC Statement or Certificate of Comparability
You must provide a statement or certificate of comparability from NARIC along with your degree
certificate. Details can be found on the NARIC website ecctis.co.uk/naric.
• Medical certificate (if applicable)
You must attach supporting medical evidence if you have a medical condition that requires adjustment(s)
during the exams. Please note the GDC may request an updated medical certificate up to five weeks
before you take the exam.
• Certificate of Good Standing
This must be issued by the dental authority in the country where you qualified, as well as from the country
in which you last worked (if different). This must be no more than three months old when received by the
GDC.

Evidence of English language
The Dentist Act 1984 requires the GDC to be satisfied that all applicants have the necessary knowledge of
English language prior to entry to our registers.
Please refer to our guidance on how you can demonstrate the necessary knowledge of English language and the
types of evidence we are likely to accept.
You must provide recent, objective evidence that you can read, write and interact effectively in English with
patients, relatives and other healthcare professionals in relation to your role as a dental professional.
I confirm that I have read and understood the English language requirements.
Please tick as appropriate the evidence that you are submitting:
International English Language Testing System (IELTS) certificate
A recent primary dental qualification that has been taught and examined in English
A recent pass in a language test for registration with a regulatory authority in a country where the first and
native language is English
Recent experience of practising in a country where the first and native language is English
Other (please provide details in the box below)

Section 4: Character reference

Your referee must be:
▪ A GDC registrant or medical practitioner who is registered in the United Kingdom and has
known the applicant for at least one year and is not a relative, OR
▪ A person of similar professional standing such as a doctor, dentist or a lawyer from the
applicant’s own country who has known the applicant for at least 12 months and is not a relative.
Please refer to the guidance when completing this form. Please write IN BLOCK CAPITALS.
First reference - Please refer to the guidance when completing this form. Please write IN BLOCK CAPITALS.
Full name of applicant
Title of referee (please tick)

Mr Mrs Miss Ms Dr Other
Full name of referee
GDC registration number (if appropriate)
Position held
Organisation/university Department/unit Address
Town/city Post/Zip code Country
Work telephone number (including STD code)
Email address (mandatory – required for verification)
Declaration
I certify that I am not a relative of the applicant that I have known them for at least 12 months that they are the
person they declare themselves to be and are of good character. The information I have provided is complete,
true and correct.
Signature Date
gdc-uk.org 5 Online Application: V

ersion 4.4 (Sept 2021)
Section 5: Clinical experience reference

First reference
Please give this to referee(s) who can verify your clinical experience. You may need to give a copy to
more than one person in order to demonstrate that you have met the 1,600 hour requirement.
There are three forms in this pack, please print more copies as required.
First reference

Position held
Organisation/University Department/Unit Address
Town/City Post/Zip C ode Country

Please confirm the level of clinical experience that you are providing a reference for on behalf of the
applicant.
Undergraduate clinical experience (Dean or Principal)

Post-qualification experience
Temporary registration experience
Place where clinical experience was gained
Date started
Completed
Job title/position of the applicant
Did you supervise the work of the applicant directly? Yes No
If the experience was as a temporary registrant please provide the applicant’s TR number

Please describe the clinical experience undertaken by the applicant including the exact number of
hours that they personally treated patients in the dental chair.
Please note that the number of hours of clinical experience must be hours the applicant has spent
undertaking investigations and administering dental treatment. It must not include time observing other
dentists or assisting other dentists/dental students in undertaking diagnosis/treatment planning or provision of
treatment.
If necessary, please continue on a separate sheet of paper and attach it to this form, indicating that you are
referring to the clinical experience requirement.
Number of clinical hours completed
The information I have provided is complete, true and correct.
Name
Signature Date


Second reference
Second reference

Position held

applicant.

Date started
Completed

treatment.
Name
Signature Date


Third reference
Third reference

Position held

applicant.

Date started
Completed

treatment.
Name
Signature Date

Application Guidance Notes for applicants and referees

Please read this guidance carefully before completing your application form and use the checklist to make sure you have
completed all sections and submitted all the supporting documents. Your application will not be processed and it will be
returned if there are documents missing or your application is incomplete.
You should complete the entire form in block capital letters.
We expect candidates to be academically and financially ready to sit an examination as soon as they send in their
application.
Candidates are allowed up to four attempts at each part of the ORE and will need to pass part 2 within five years of first
sitting Part 1.
If you have any queries after reading these guidance notes please email the exams team, examinations@gdc-uk.org.
Your details
• Title
You may not use Doctor (Dr) unless you hold a doctorate in addition to your primary dental qualification.
• Given or first name

Please provide your full given or first name and middle names exactly as they appear on your passport and
degree certificate.
• Family name or surname

Enter your full family or surname exactly as it appears on your passport and degree certificate. This is the
name you will be registered under for the ORE so it is essential it is recorded correctly.
If you have changed your name by marriage or Deed Poll you must provide evidence of this change with your
application in the form of the original certificate, affidavit or other statutory evidence.
You should check whether you are eligible for registration through any other route on our website gdc-uk.org
Your contact details
• Address
The address you provide will be used to contact you if we need to return incomplete forms or documents. If your
address changes you must notify us by email, or by sending in a signed and dated letter with your new address
clearly marked with your name and GDC reference number.
• Email address
You must have an email address that you can access frequently as we use email as our main form of
communication for exam announcements, reference checking and results.
• Telephone numbers
All telephone numbers should be given in full with STD codes as we may need to contact you by telephone
regarding your application or exam place.
Please notify us immediately if your address, email or telephone number changes.

Data Protection
Under the General Data Protection Regulation and Data Protection law, the GDC processes personal data, like the
information in your application, because the processing is necessary for the exercise of the GDC’s statutory functions;
and the processing is also in the substantial public interest.
Information about how the GDC will use and share the information you give us, the various rights you have in connection
with any personal data about you that is held by the GDC, and how long we will keep your information for can be
found in the privacy notice on our website gdc-uk.org/privacy.
Qualification
You must state here which institution you received your original primary qualification from, the country of qualification and
the title of your primary dental qualification e.g. BDS, University of Health Sciences, Lahore, India.
Supporting documents
You must enclose an original IELTS certificate, original Certificates of Good Standing and an original NARIC
statement/certificate of comparability. You may supply copies of all other documentation as long as these documents
have been certified by someone named in guidance notes. Please refer to the guidance notes for a list of people who can
certify documents.
Your full name (including any middle names) and date of birth should match on all of your supporting documentation
unless you have provided evidence of a change of name. If the name on any of your supporting documents does not
match, for example your middle name does not appear on your degree certificate; you must obtain an affidavit confirming
that you are the person stated on the document.
All photocopied documents must be certified. We can only accept certified copies if all the following criteria apply:
• The documents are legible

• The copy is taken from the original document (we cannot accept copies of photocopies or faxes)
• The person certifying confirms (in English) by signing and dating the document that it is a true copy of the original
• The person certifying is either a Notary Public, Commissioner of Oaths, Justice of the Peace or another person
entitled to practise law, or an authorised officer of an embassy or consulate
• The name, signature and address of the person certifying is shown on the copy
• The person certifying is not a relative of yours.
The applicant cannot certify documents themselves.
We do not accept photocopied documents verified by a GDC registrant.
Your primary dental degree certificate
Please send us a certified copy of the original certificate. If your name on the certificate does not match your passport
please provide an affidavit to confirm that you are the holder of the degree.
A provisional certificate or certificate of graduation will not be accepted in place of a final degree certificate or diploma.
NARIC Statement or Certificate of Comparability

You must provide a statement or certificate of comparability from NARIC along with your degree certificate. Details
can be found on the NARIC website ecctis.co.uk/naric.
We may ask for additional information to verify the authenticity of your degree certificate.

Passport
Please send us a certified copy of your current, valid passport. It must:
• Be legible
• Show a clear photograph
• State expiry date of your passport
• Indicate your date of birth, and
• Clearly show your signature.
Passport photo
You must supply us with a recent passport sized photo that has been certified by your character reference on the back of
the photo.
The requirement for individuals applying for registration or restoration with the GDC to submit a passport photo is aligned
with the UK Government requirements.*
You must make sure that your passport photo meets these requirements otherwise there may be delays to your
application.
Your photo must be professionally printed and 45 millimetres (mm) high by 35mm wide - the standard size used in photo
booths in the UK.
Your photo must be:
• in colour on plain white photographic paper

• taken against a plain cream or light grey background
• taken within the last month
• clear and in focus
• without any tears or creases, and
• unaltered by computer software.
The image of you - from the crown of your head to your chin - must be between 29mm and 34mm high (see example
below).
*Contains public sector information licensed under the Open Government Licence v3.0.
Variations in your name

If the name in which you are applying for the ORE differs from that on any of the other documents you are sending, you
must provide evidence of the legality of your name change, e.g. a marriage certificate. In this instance please send us a
certified copy of the original. Alternatively, please provide an affidavit confirmed by a solicitor, detailing the variations of
your name on your documents and that they all relate to you.

Medical certificate
You must attach supporting medical evidence if you have a condition that requires adjustment(s) during the exams.
Please note the GDC may request an updated medical certificate up to five weeks before you take the exam.
If you have not supplied a medical certificate with this application, please tell us about any adjustments arising from
additional needs that you may require during an exam. It is your responsibility to tell the exams team of any additional
needs or changes that may arise. You must do this at least five weeks before an exam sitting. The exam centres cannot
guarantee any adjustment but will consider it and advise you accordingly.
Evidence of English language

The Dentists Act 1984 requires the GDC to be satisfied that all applicants have the necessary knowledge of English prior
to entry to our registers.
If the GDC is satisfied about your knowledge of English from your initial application for registration we will not request
further evidence or information.
If the GDC is not satisfied that you have produced sufficient evidence that you have the necessary knowledge of English
we will request further evidence and/or information. Please refer to “Evidence of English language competence:
guidance for applicants” document, which can be found on the GDC website gdc-uk.org for types of evidence we are
likely to accept as demonstrating that a dental professional has the necessary knowledge of English.
If this further evidence still does not satisfy us, we will direct you to undertake a test before we allow you to enter the
ORE. The test that we will direct you to undertake is the International English Language Testing System (IELTS) exam.
You must achieve the pass scores relevant to your profession.
Certificate or Letter of Good Standing

This is a certificate or letter issued by the dental authority of the country in which you last worked which states that you
are legally entitled to practise dentistry in that country and that you have not been suspended, disqualified or prohibited
from working as a dentist.
You must also send us a Certificate or Letter of Good Standing from the dental authority in the country in which you
qualified if this is different to the country in which you last worked or are currently working.
This document must be:
• An original certificate or letter on letter headed/watermarked paper
• No more than three months from the date of issue at the time of your application.
If you cannot obtain this document due to the regulations of the dental authority in the country in which you qualified, you
must provide a letter from that dental authority which explains why a Certificate or Letter of Good Standing cannot be
provided. In addition you must provide an affidavit or affirmation witnessed by a solicitor or other legal professional,
confirming that you are of good standing. This will be considered on a case by case basis.
If you cannot obtain this document due to your refugee status, you will also need to provide an affidavit or affirmation
witnessed by a solicitor or other legal professional confirming that you are of good standing. This is only acceptable if it
is not possible to obtain a Certificate or Letter of Good Standing and will be considered on a case by case basis.
You must be prepared to swear under oath in the affidavit/affirmation that you cannot obtain the Certificate or Letter of
Good Standing despite having tried to. In the affidavit/affirmation you must state that you have the right to practise
dentistry in the relevant country and that you have not been suspended or prohibited from practising as a dentist.
Reasons for being unable to obtain a Letter or Certificate of Good Standing must be included. We may also seek
confirmation from the relevant authority.
A registration certificate or an annual practising certificate or a reference from your university will not be accepted in
place of a Certificate or Letter of Good Standing.

Translations
Any required documents which are not in English must be accompanied by an exact translation. You must send us a
certified copy of the original document and the certified translation. The translation must either be:
• A certified translation by a qualified translator, or
• For degree certificates and diplomas, an official translation by the relevant university with the official stamp of
the university and the signature and name of the Dean.
The General Dental Council will not refund any fees for translation.
Declaration
Please ensure that all your details are correctly and accurately completed before you sign and date your application.
• Please complete the Checklist included at the front of the application form confirming the documents that you
are submitting.
• Please do not submit a form which is dated more than three months ago.
• We will return your documents once we have processed your application. The address you supply must be one
where you can receive these documents.
Character reference
Your character referee must sign the form after you have signed and completed sections all sections
The date the referee signs must not be earlier that the date you have signed.
The referee must be a registered professional and must not be a relative.
Clinical experience reference
You must provide one or more references, dated no longer than three months ago, to demonstrate you have completed at
least 1,600 hours of clinical experience prior to applying for the ORE.
You may need to submit more than one clinical reference in order to satisfy the 1,600 hours requirement. We have
provided three forms, and you may print as many additional copies of section 7 as you need from our website in order to
send each referee a separate copy. If one reference satisfies the 1,600 hours requirement we do not need additional
references.
Your referees must complete this section of the application form to verify that you have this experience, providing details
of your clinical experience. They may continue on additional sheets if necessary.
If you are submitting evidence from your primary dental qualification as evidence of prior clinical experience, the Dean of
the dental school or your professor/tutor acting on behalf of the Dean must be the referee. Please ensure that the Dean’s
office stamps the form in all cases.
If you are submitting evidence from post-qualification work experience, the person verifying the reference must be, or
have been, registered as a professional with the regulatory body in the country where you worked or studied and must
be, or have been, your employer.
If you are submitting evidence gained in the UK under temporary registration, the form must be completed by the
supervising consultant(s) responsible for supervising your direction(s).
If you are unable to submit evidence of your clinical experience because you are a refugee or asylum seeker, please
contact us to discuss alternative methods of verification.

Exam rules
Late arrivals at the exam
Candidates who arrive late will not be admitted to that section of the exam. Candidates will be allowed to take any
later sections of part 2; however marks will not be provided for these sections. This will count as one of the four
attempts allowed.
Cheating and misconduct

Any of the following examples of misconduct will result in the candidate failing the exam and may impact on GDC
registration should the candidate subsequently pass the ORE:
• introduction of unauthorised material into the exam room, for example: notes, textbooks or study guides,
personal organisers, calculators, dictionaries, personal stereos, concealed mobile phones or other similar
electronic devices
• obtaining, receiving, exchanging or passing on information which could be exam-related (or the attempt to)
during the exam by means of talking, written papers/notes, by telephone or by recording oral exams
• attempting to solicit information about the exam from candidates from an earlier time slot
• copying from another candidate
• collusion
• disruptive behaviour in the exam room (including using offensive language)
• failing to abide by the conditions of supervision designed to maintain the security of the exams
• failing to abide by the instructions or advice of an examiner, academic lead or administrator in relation to the
exam rules and regulations
• impersonation: pretending to be someone else, arranging for a third party to take the candidate’s place in an
exam
• the inclusion of inappropriate, offensive or obscene material in answers
• misuse of exam material, e.g. by passing or attempting to pass such material to a third party after the exam;
• bribing or attempting to bribe an exam official
• the alteration of any results document
• behaving in such a way as to undermine the integrity of the exam.
• contacting or attempting to contact internal or external examiners before or after the exam for any reason.
• making spurious complaints that are a deliberate attempt to unfairly gain advantage.
Mobile telephones
It is accepted that for reasons of personal safety, including emergency contact with friends and family, candidates cannot
be forced to leave mobile telephones behind when attending on the day of the exam. However, we reserve the right to
ask candidates to switch off their telephones and place them in a clear plastic bag and ensure that this is on display at all
times, or to leave the telephone in designated secure storage at the place of the exam and for the
duration of the exam only. Candidates found with concealed mobile telephones or other electronic devices during the
exam will fail the exam and this may impact on GDC registration should the candidate subsequently pass the ORE.

Illness
• Candidates who are unwell should speak immediately with the GDC external examiner. They will write a detailed
note of all the information given to him and send this to the exams team as soon as possible.
• Candidates who are unwell must make a professional decision as to their fitness to continue with the exam.
• You should be clear as to the consequences of your decision. All candidates should read and understand the
policy regarding illness before the exam. This can be found on our website.
• If you are not fit to continue with the exam you will keep the results you have earned up to that point. This means
that candidates who have passed all the sections of the exam up to the point of departure will be entitled to sit the
exam again for free once an acceptable original medical certificate has been received by the exams team.
Candidates who have already failed before they leave the exam will still have failed the exam and the results will
not be changed retrospectively on production of a medical certificate.
• Candidates who decide that they are fit to continue with the exam will not have their results changed
retrospectively on production of a medical certificate.

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Your application and supporting documents should be returned to:

Overseas Registration Exam

Application form Character reference Clinical experience reference(s)

Certified copy of passport One passport photo Original NARIC statement/certificate

Original Certificate of Good Standing Certified copy of degree certificate

Original translation of documents (if applicable) Medical certificate (if applicable)

Evidence of name change (if applicable) Evidence of English language

Original academic IELTS test report form

Please note if your application is incomplete it will be returned to you.

gdc-uk.org 1 Online Application: Version 4.4 (Sept 2021)

Section 2: Declaration AS05ORED635L

Please note if your application is incomplete it will be returned to you.

gdc-uk.org 2 Online Application: Version 4.4 (Sept 2021)

Section 3: Primary dental qualification

Year degree awarded

ii. Original documentation

gdc-uk.org 3 Online Application: Version 4.4 (Sept 2021)

Evidence of English language

Please tick as appropriate the evidence that you are submitting:

International English Language Testing System (IELTS) certificate

Other (please provide details in the box below)

gdc-uk.org 4 Online Application: Version 4.4 (Sept 2021)

Section 4: Character reference

Title of referee (please tick)

Full name of referee

GDC registration number (if appropriate)

Organisation/university Department/unit Address

Town/city Post/Zip code Country

Work telephone number (including STD code)

Email address (mandatory – required for verification)

gdc-uk.org 5 Online Application: V

Section 5: Clinical experience reference

Title of referee (please tick)

Full name of referee

GDC registration number (if appropriate)

Organisation/University Department/Unit Address

Town/City Post/Zip C ode Country

Work telephone number (including STD code)

Email address (mandatory – required for verification)

gdc-uk.org 6 Online Application: Version 4.4 (Sept 2021)

Undergraduate clinical experience (Dean or Principal)

Place where clinical experience was gained

Job title/position of the applicant

Did you supervise the work of the applicant directly? Yes No

gdc-uk.org 7 Online Application: Version 4.4 (Sept 2021)

Number of clinical hours completed

The information I have provided is complete, true and correct.

gdc-uk.org 8 Online Application: Version 4.4 (Sept 2021)

Section 6: Clinical experience reference

Title of referee (please tick)

Full name of referee

GDC registration number (if appropriate)

Organisation/University Department/Unit Address

Town/City Post/Zip C ode Country

Work telephone number (including STD code)

Email address (mandatory – required for verification)

gdc-uk.org 9 Online Application: Version 4.4 (Sept 2021)

Undergraduate clinical experience (Dean or Principal)

Place where clinical experience was gained

Job title/position of the applicant