Nurses and Midwives Council of Belize logo

Nurses and Midwives Council of Belize

Cor. Princess Margaret Drive & St. Joseph Street, Belize City · P.O. Box 933 · Tel: +501 233-3466

Application for Renewal of Licence

Complete all applicable sections. Write clearly in block letters.

Payment must be made before submission. Attach a clear copy of the payment receipt, proof of 60 hours of continuing education completed within the last two years and photocopies of all required supporting documents. Attach a current police record if available or requested by the Council. Incomplete application packages may not be processed.

Renewal Fee Schedule

Select the correct category and pay the total shown. All totals include the BZ$20.00 licence-card fee.

1. Renewal Details

Current Licence / Registration Number
Current Expiry Date
Renewal Period, e.g. 2027-2028
Amount Paid (BZ$)

Credential: Please check as appropriate.

Advance Practice Nurse (APN) Public Health Nurse (PHN) Clinical Nurse Specialist (CNS) Rural Health Nurse (RHN) Registered Nurse (RN) Practical Nurse/Midwife (PN/M) Registered Nurse Midwife (RNM) Certified Operating Room Technician Practical Nurse (PN) Certified Dialysis Nurse Other: ____________________

2. Applicant Information

Surname
First Name
Middle Name
Civil Status
Sex
Date of Birth
Country of Birth
Country of Residence
Nationality
Phone Number
Email Address
Home Address

3. Employment Information

Present Employer
Employer's Telephone Number
Employer's Address
Current Position/Title
Employment Status

4. Payment Information

Payment Date
Payment Method
Receipt / Transaction Number
Amount Paid (BZ$)
Financial InstitutionBelize Bank Limited Account NameThe Nurses and Midwives Council of Belize Account Number233986010120025 Payment ReferenceApplicant's full name and licence number

5. Documents Attached

Copy of payment receipt Copy of current / most recent licence Copy of valid identification Proof of 60 hours of continuing education completed within the last two years Current police record, if available/requested Additional documents requested by Council Other: ____________________

6. Declaration

I declare that the information provided in this application is true and complete. I understand that payment and submission do not guarantee approval and that the Nurses and Midwives Council of Belize may request additional information or original documents.

Signature of Applicant
Registration / License No.
Date