UK Tuberculosis Detection Programme

Applicant Registration

Step 1 of 4
Main Information

	* Date of First Contact:

		Please select the country where you want to book a medical appointment.
	* Country of Assessment:
	* City of Assessment:
	* IOM Mission:

	* Visa Type:

		Please type your name in the same way it is found in your passport.
		If you only have one name, please enter it in the "Last(Family) Name" field.
	* Last(Family) Name:
	First Name:
	Middle Name:
	Full Name as in the Passport:	Full Name as in the Passport The applicant's name in his native land. (Write using his native alphabet if needed.)
	* Gender:	Male Female
	* Date of Birth:	(ex. 01-Jan-1970)

Step 2 of 4
Secondary Information

	* Country of Nationality:
	Citizen Id:	Citizen Id Applicable to countries with citizen IDs.
	* Passport Number:
	Passport Issue Date:	(ex. 01-Jan-1970)
	Passport Expiry Date:	(ex. 01-Jan-1970)
	* Residential Address Line 1:
	Residential Address Line 2:
	* Town or City:
	* Country:

	* Primary Phone Number:	(ex. +66 1234 5678)
	Secondary Phone Number:	(ex. +66 8 1234 5678)
	Other Phone Number:	(ex. +66 1234 5678)
	* Email:

Step 3 of 4
UK Contact Details


	*Proposed UK Address Line 1:	Proposed UK Address Line 1 Please enter "-" if unknown
	Proposed UK Address Line 2:
	*Town or City:
	*Postcode in UK:
	*Telephone in UK:	Telephone in UK Please enter "-" if unknown

	Applicant is being sponsored to come to the UK:	Yes No
	Type of sponsor:	Education Employer Family Other

	Sponsor's Name:
	Sponsor's Address:
	Sponsor's Postcode:
	Sponsor's Telephone No.:

Step 4 of 4
Security Verification


	Secret Question:
	*
	*Secret Answer:

		Enter the Verification Code shown below Verification Code This code helps prevent automatic registrations.

	* Verification Code: