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Required PVG Information
MrMsMissMrs
Present Surname*
First Names (all)*
Any Previous Surnames ( Include maiden names & married name, one per line)
Any Previous Forenames
Mother’s Maiden Name or Family Name*
Date of Birth (DD/MM/YYYY)*
Town of Birth*
Country of Birth*
Nationality*
Day Contact No.
Evening Contact No.
email Address
Do you wish to apply for an Online Account with Disclosure Scotland? YesNo
National Insurance No.
Passport No.
Passport Country of Issue
Driving Licence No.
Driving Licence Country of Issue
National ID card No.
National ID Country of Issue
National Entitlement Card No.
National Entitlement Card Country of Issue
Electricity Supplier No.
Are you now or have you ever been a member of the PVG Scheme YesNo
PVG Scheme ID
Are you now, or have you ever been registered with the ISA? YesNo
ISA registration No.
Please provide your address history in the last 5 years, starting with your current address.
Current Address:
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Post Town
County
Postcode
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Resident From (MM/YYYY)
Previous Address 1:
Previous Address 2:
Previous Address 3:
Previous Address 4:
Are you registered with:
Care CommissionHealth Profession CouncilGeneral Chiropractic CouncilNursing and Midwifery CouncilGeneral Dental CouncilRoyal Pharmaceutical Council of G.BGeneral Medical CouncilScottish Social Services CouncilGeneral Optical CouncilGeneral Teaching Council for ScotlandGeneral Osteopathic Council
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