Doctor’s name and address
GMC Full Registration Number
Dates between which training took place, and total duration of training in months
Whether training was full-time or part-time, and if part-time, what ratio to full-time
Name and address of hospital or community post
Number of hospital or community post or other reference, where available
Name of post and hospital grade, if appropriate
Specialty of post
Name, grade and professional address of doctor supervising training
Statement of satisfactory completion of training
Date of signatures required by regulation 9(5)(b)