Removal from the register - OTBNZ | The Occupational Therapy Board of New Zealand (OTBNZ) is a regulatory authority for occupational therapy practitioners.

Full Name *

Registration number (if known)

Contact email *

I would like my name removed from the register *

Yes

No

I understand that this means I cannot hold myself out to be a registered occupational therapist *

Yes

No

I understand that I cannot work as an occupational therapist in New Zealand, and my name will not appear on the public register *

Yes

No

I understand that I may apply for restoration of my name to the Register at any time. My application will be subject to the registration policies and fees applicable at that time *

Yes

No

I understand the OTBNZ will continue to securely hold personal information about my registration. The OTBNZ personal information policy is available here *

Yes

No

My reason for requesting removal from the register is (optional)

Signature *

Date *

Request removal from the register