Kenya Medical Laboratory Technicians and Technologists Board
Defer Examination Application
File No
Index Number
Date
Exam Series/Year
Full Name
ID Number
Mobile
Email
P.O. Box
Date of Birth
Nationality
Training Institution
Academic Qualification
Professional Qualification
Defer Exam Schedule
Reason Type
-- Select Reason --
Medical
Psychological
Compassionate
Upload Medical Report
Declaration (Full Name)
Signature Date
Submit
