Page 1 of 2 Tel: +353 (1) 639 8500 Fax: 353 (1) 639 8595 Website: www.nursingboard.ie

Overseas Registration Application Request Form All applicants who trained outside Ireland (Groups 1, 2 and 3) should complete and return this form along with the assessment fee.

You must complete the credit card mandate on page 2 to pay this fee. Once we have received and processed this form, we will send you a full application pack.

Country in which you trained as a nurse or midwife

Date you started your initial nursing or midwifery training Title (Miss/Ms/Mrs/Mr/other)

Surname (as per birth or marriage cert)

Forename/s (as per birth cert)

Date of birth

Email address

Mobile number

Contact address Must be your own address

NMBI PIN (if already registered in another division)

* Only currently licenced recruitment agencies will be allowed to act on behalf of an applicant. The recruitment agency must hold a current valid licence with the Department of Jobs, Enterprise, Skills and Innovation in Ireland.

I wish to apply for registration in the following division(s) of the Register (please appropriate box)

General Nurse Midwife Psychiatric Intellectual Disability Nurse

Children's Nurse Public Health Nurse Nurse Tutor Nurse Prescriber

Signature

Date

Page 2 of 2

Tel: +353 (1) 639 8500 Fax: 353 (1) 639 8595 Website: www.nursingboard.ie

Assessment fee

All Group 1, 2, and 3 applicants must pay an assessment fee. This fee covers the cost of assessing your application.

If you are applying for registration with NMBI for the first time, then you need to pay an assessment fee of 350.

Your assessment fee will cover the cost of applying for multiple divisions of the Register, provided that you include

all divisions on your application request form.

If you are already registered with NMBI, and you are applying to register an extra qualification that you obtained

outside of Ireland, then you need to pay an assessment fee of 200.

Registration fee (not payable at this time) After we have assessed your application, we will issue you with a decision letter to let you know the outcome of your

application. If you are eligible to join the Register, then you will need to pay a registration fee:

145, if this is your first time registering with NMBI 80, if you are already registered with NMBI

Credit Card Mandate assessment fee payment

Please ensure your Debit/Credit Card is current and there are sufficient funds to meet the payment. Prior

to sending your application request, you may need to notify your bank of an upcoming foreign credit card

transaction. Failure to do so may result in your transaction being declined.

By signing this form, I authorise the Nursing and Midwifery Board of Ireland to deduct the appropriate

assessment fee form my credit/debit card:

For office use only: Reference No: Transaction No:

Return completed form to:

The Nursing and Midwifery Board of Ireland,18/20 Carysfort Avenue, Blackrock, Co Dublin, Ireland

Important notice

Please make sure that you have read all the information about the application process and documentation requirements before you apply. The assessment fee is non-refundable.