Date of Diploma (DD/MM/YYYY) – Note 1 Extension for Medical degree ONLY – Note 2 Maternity leaves (No. of children) – Note 3 Other career breaks (days) – Note 4 Blocking Period No blocking Blocked from SyG with score C last year Blocked from SyG with score B last year Blocked from StG/CoG/AdG with score C in the last two years Blocked from StG/CoG/AdG with score B in the last year submit