Clear form APPLICATION for Swedish LICENCE to

PRACTISE on basis of training in an EEA-

country other than Sweden or in Switzerland
Personal particulars given in this application form will be Directive 2005/36/EC
registered by the National Board of Health and Welfare in a
fileprocessing system. Particulars about the awarded quali-
fications will be transferred to the Board’s registers and are Send to
automatically updated by means of national registration. Socialstyrelsen
Enheten för behörighet och patientsäkerhet
SE-106 30 STOCKHOLM
SWEDEN
Personal data
Surname First name, middle name(s)
Start here
Postal address Swedish personal number/date of birth

Postcode City/post office Phone number

Country Gender Citizenship

M F
E-mail

Medical and paramedical profession Mark one (1) box only

audiologist medical physicist physiotherapist
biomedical scientist midwife prescriptionist
chiropractor nurse responsible for general care psychologist
dental hygienist occupational therapist psychotherapist
dentist optician radiographer
dietician orthopaedic engineer speech therapist
doctor of medicine pharmacist

Vocational qualification
Description/name of examination (title) Date of graduation Licence/registration (date) in the country of education

Duration Country of education Licence/registration in an EEA-country other than the country

(number of years) of education, which one?

Other relevant information

Enclosures
This application must be supported by certified copies of the following documents:
1. Diploma, certificate or other evidence of formal qualification and registration of licence in the country of education.
2. Birth certificate/copy of passport. Applicants residing in Sweden should enclose a “svenskt personbevis” instead (must not be
older than three months).
3. European certificate of current professional status. This certificate is a statement that the applicant is entitled to practise his/her
profession in the country of education without limitation. This certificate has to be issued by the competent authority in the country of
education or from the EEA-country where the applicant was last established professionally. The certificate has to be presented in its
original form and must be issued within the last three months. The certificate must be written in English or accompanied by a trans-
lation into English or Swedish. The translation must be made by an authorized translator. If the applicant is able to submit a certified
copy of licence from another Nordic country this certificate is not required. Socialstyrelsen will ask for this information directly from
the competent authority in this Nordic country.
4. Summary of formal qualifications and professional experience must be presented.
SoSB 45355 2008-01 pee

The copies must be certified to be true copies by an authority, professional organisation or an institution.

Signature
City, date Signature of applicant