The Fook Yoo Chronicles, V1

Address continuation sheet

If necessary, this sheet should be used in conjunction with an AccessNI Disclosure Application Form. Please complete the details at Part A and add (at Part B) the remaining 5year address history details for which there was insufficient room on the Disclosure Application Form. Please ensure you sign and date this sheet at Part C.

PART AA1 Surname

Applicants details

A2 Forename(s) A3 Date of birth

D D / M M / Y Y Y Y

PART BB1 Address

Address history (continued)

B2 Town / City B3 County B4 Postcode B5 Lived at this address from B6 Address

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

B7 Town / City B8 County B9 Postcode B10 Lived at this address from B11 Address

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

B12 Town / City B13 County B14 Postcode B15 Lived at this address from

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

PART C

Applicants signatureC2 Date of Signature

C1 Signature of Applicant (please sign in box)

D D / M M / Y Y Y Y

Access NI PO Box 1085 Belfast BT5 9BD

QUICK GUIDE FOR COMPLETING: ENHANCED DISCLOSURE APPLICATION FORMPlease complete this Application Form in CAPITAL LETTERS, using black ink. Applicants must complete Parts B, D, E, F and G and return the Form to the Registered Body for completion of Part A, H, I and J. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed.

PART A TYPE OF APPLICATIONIndicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. A1 A2 A3 A4 Please indicate which disclosure you are requesting, X one box only Enter Registered Body Name Enter 10 digit Registered Body Number Enter 10 digit Countersignatory Number (this should not be completed until after the Applicant has completed their details onto the Form)

PART B PERSONAL DETAILSB1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. B2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. B3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. B4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. B5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc. B6 Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes, complete E1- E4, if no, go to B7. B7 Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes, complete E5 - E8. B8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice.

B9 Date of Birth - enter the day, month and year you were born in the format DD/MM/ YYYY - e.g. 04/03/1960. B10 Place of Birth - enter the name of the town and the country where you were born. B11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. B12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). B13 Do you hold a valid passport? - if no, go to B17, if yes, you must complete B14, B15 and B16. B14 Passport number - enter passport number. The passport should be valid. B15 Nationality - enter your nationality as indicated on your passport. B16 Country of issue - enter the country your passport was issued in. B17 Do you have an ISA registration number - Do not complete. B18 ISA Registration number- Do not complete. B19 Do you have a Scottish Vetting & Barring number - Do not complete. B20 Scottish Vetting and Barring Number - Do not complete. B21 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary.

PART D - APPLICANTS CURRENT AND DELIVERY ADDRESSD1-D6 Current Address - please note that this will be the delivery address of the Disclosure Certificate. It should be your home address or, where this is not possible, Halls of Residence or temporary lodgings. Also include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D6. If the date is within the last 5 years you must complete additional addresses to cover the full 5 years in Part E. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. D7 D11 Delivery Address (if different) - this is the address to which you would prefer AccessNI to forward the Disclosure Certificate to. If it is the same as your current please leave blank.

PART E - ADDRESS HISTORYE1-E12 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni. gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf.

PART F - NAMES HISTORYOnly applies if you have any previous surnames or forenames not recorded in Part B6 and B7. This should be completed if you have answered yes to B6 or B7. There must be no gaps in the dates; overlapping dates are acceptable. F1-F4 - Insert any additional surnames used, and dates. F5-F8 - Insert any additional forenames used, and dates. If necessary, please use an additional page, clearly writing your current name and date of birth at the top of the page.

PART G DECLARATION BY APPLICANTPlease read this section carefully as it is where you declare that all the information provided is correct and up to date and where you are informed that AccessNI will use the information supplied to verify your identity against information held on Police and Government data bases. If necessary information provided may be used to update or perfect records already held within such data bases. In addition AccessNI may pass the information provided on this form to Police, Government Organisations and law enforcement agencies for the purposes of the protection and detection of crime. All Sharing of information with be in accordance with section 29 of the Data Protection Act 1998 and AccessNIs Information Charter (see guidance on website for this http://www. dojni.gov.uk/index/accessni/about-ani/accessni_information_charter_-_sept_2012.pdf). G1 G2 G3 G4 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. Signature of Applicant - place your signature ensuring it stays within the box provided. Date of Signature. Insert your name in CAPITALS.

PART H REGISTERED BODY INFORMATIONIs the applicant applying for an AccessNI disclosure - must be Yes. Position applied for - please ensure the position applied contains clear evidence for the request. It must be obvious the position qualifies for an enhanced disclosure. H3 Organisation name - the description you enter here will be recorded on the certificate H4 Will the work be carried out at the home of the applicant? - if Yes, this will determine whether further checks on others in the household are required. One box must be X.. H5 Is the disclosure required for the purpose of asking an exempted question? Enhanced Disclosures can only be provided if the position applied for H2 is exempt from the provisions of set out in the Rehabilitation of Offenders (Northern Ireland) Order 1978 - it is the responsibility of the Counter Signatory to ensure this is the case. If No, is marked with X then the form will be returned unprocessed. H6 Is the disclosure required for a prescribed purpose - this must be X Yes. If you are unsure a list of prescribed purposes can be viewed on our website. H7 Does this position require a check of the Childrens Barred List (Regulated Activity) Insert X at No unless applying for Enhanced with Barred List Check at A1. Insert X at Yes if appropriate. H8 Does this position require a check of the Vulnerable Adults Barred List (Regulated Activity) Insert X at No unless applying for Enhanced with Barred List Check at A1. Insert X at Yes if appropriate H9 Have you established the true identity of the applicant by examining a range of documents as set out in AccessNI guidance, and verified the information provided in Parts B, D, E & F. This box must be X Yes or the form will be returned. H10 Application Type - please indicate if the post is for an New Post Holder, Existing Post Holder, Re Check of existing post holder. H11 Your reference number. If you require a number which you would like to appear on the certificate please enter it here i.e. an internal recruitment code. Do not use Countersignatory number. H7 & H8 - IF APPLYING FOR ENHANCED WITH BARRED LIST CHECK AT A1 AT LEAST ONE OF THESE BOXES MUST BE YES. H1 H2

PART I PAYMENTI1 Please X the appropriate box. Account Invoices will issue at the beginning of each month and will include charges for Disclosure Certificates issued during the previous month. Acceptable payment methods can be found on page 1 of the invoice. No Payment (Volunteer) Access NI will provide free disclosure services to volunteers who meet the AccessNI definition. Further details can be found on http://www.dojni.gov.uk/index/accessni/whouses-ani/volunteers.htm.

PART J DECLARATIONPlease read the declaration and sign. This is the Registered Body statement that all documentation has been supplied and checked in accordance with AccessNI guidance. J1 J2 J3 Signature of Registered Person - this must be an original signature. Date of signature - must always be within 3 months from the date received by AccessNI. Name in CAPITALS


QUICK GUIDE FOR COMPLETING: ADD COUNTERSIGNATORYThe Registration Form must be completed by an appropriate person in the organisation who wishes to become a Countersignatory with AccessNI. Please complete this form using black ink only and CAPITAL letters. If you would like your certificate to be delivered to a different address other than that held for your organisation please complete B7 B11. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed. PART A TYPE OF APPLICATION Indicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. PART B PERSONAL DETAILS A1 Initial Registration A2 Modify Registration details A3 Add Countersignatory A4 Modify Lead Countersignatory A5 Remove Lead / Countersignatory A6 Change Designated Lead Signatory PART B ORGANISATION DETAILS B1 Registered Body Number - this does not need to be completed for initial registration but for all other modifications this section must be completed with the Registered Bodys reference number which was provided by AccessNI. B2 Organisation name - this is the name of your organisation B3 Umbrella body - mark the box if you will be acting as an Umbrella body for other organisations for the purpose of countersigning Standard and Enhanced Disclosure Applications and/or ISA Registration Applications. B4 and B5 Regulated / Controlled activities - one or both these must be marked if the organisation is entitled to ask the exempted question (refer to the Safeguarding Vulnerable Groups (NI) Order 2007 for clarification on definitions or contact the ISA helpline on 0300123 1111. B6 This organisation is classed as non-profit making and non-statutory. It is essential that AccessNI is informed of the organisations status in this respect. One box must be X. B7-B11 Office Address this is the address where any correspondence from AccessNI will be sent.

B12 Organisation Telephone Number - enter the Registered Bodys telephone number with the STD code at which AccessNI will be able to contact a Countersignatory if necessary. Please note that if this is left blank it could result in delaying processing your registration. Do not leave any spaces when entering the number. B13 Fax Number - enter the Registered Bodys fax number with the STD. Do not leave any spaces when entering the number. B14 Organisation Website Address - please insert your organisations website address. B15 Purpose of the organisation - this should be a summary of the aims and objectives of the organisation. Additional pages may be used if necessary. B16 Charity/Company number - this is the unique Charity/Company number of your organisation - if applicable. B17 Exempted Questions - this is the confirmation that the organisation will be asking exempted questions. It is important that the organisation thoroughly check they have an entitlement to ask this question. B18 Part V of the Police Act - this is the confirmation the organisation is likely to countersign Disclosure Applications under Section 113A and/or 113B of Part V of the Police Act 1997 at the request of bodies or individuals asking the exempted questions (Umbrella Bodies only). B19 Code of Practice - this is the declaration that the organisation will comply with AccessNIs Code of Practice and will address issues raised by AccessNI to ensure adherence to its policies. This box must be marked to enable AccessNI to proceed with the registration. Details of the Code of Practice and the Explanatory Guide can be found at http://www.dojni.gov.uk/index/accessni/support/code-of-practice.htm. B20 Number of Disclosures - please estimate the number of each type of service listed the organisation is likely to countersign per year. PART C - PROPOSED METHOD OF PAYMENT FOR DISCLOSURE APPLICATIONS C1 Please indicate here if Standard or Enhanced Disclosure Applications or ISA Registrations will be paid for. You must X one box. C2 If you have answered yes above please indicate the proposed method of payment. PART D LEAD / COUNTERSIGNATORY DETAILS D1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. D2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. D3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. D4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. D5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc. D6 Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes please insert names and dates.

Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes please insert names and dates. D8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice. D9 Date of Birth - enter the day, month and year you were born in the format DD/MM/YYYY e.g. 04/03/1960. D10 Place of Birth - enter the name of the town and the country where you were born. D11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. D12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers) D13 Do you hold a valid passport? - if no, go to D17, if yes, you must complete D14, D15 and D16. D14 Passport number - enter Passport number. The passport should be valid. D15 Nationality - enter your nationality as indicated on your passport. D16 Country of issue - enter the Country your passport was issued in D17 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary. D18 Business E-mail Address - enter the email address you wish to be contacted on. D19-D24 Current Address - include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D24. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. D25-D36 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf. PART E DECLARATION BY APPLICATION Please read this section carefully as it is where you declare that all the information provided is correct and up to date. You must provide your signature and ensure that you print your full name and enter the date on this section of the form. E2 Do you have any convictions - Have you ever been convicted in a court of law. Place a cross in the relevant box. E3 Signature of Applicant - place your signature ensuring it stays within the box provided. By signing the box below you are agreeing to the above conditions of Registration. E4 Date of Signature. E5 Insert your name in capitals.

D7

PART F VERIFICATION OF IDENTITY Please see the Guidance Notes or AccessNI website for acceptable means of identification. Photocopies of identification documents must be included with the registration form when applying. Do not send original Identification Documents. F1 Please X this box to indicate the appropriate documentation has been submitted PART G DECLARATION This is the declaration that you can ask an exempted question under the terms of The Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 and that the checks requested are in accordance with the relevant sections of Part V of the Police Act 1997. The proposed Countersignatory must sign and date this section. G1 Signature of Applicant - place your signature ensuring it stays within the box provided. G2 Date of Signature. By signing the box below you are agreeing to the above conditions of Registration. PART H AUTHORISATION Do not complete this section for Initial Registration. H1 H2 This is the name and reference number of the Lead Signatory in the organisation who will approve countersignatories and validate identity. H3 Please X this box to confirm the identity of the proposed Countersignatory has been checked in line with the AccessNI identification documents. H4 This Lead Signatory must X this box to confirm the information and changes requested are necessary to maintain an accurate and up-to-date AccessNI registration for the Registered Body. H5 H6 The Lead Signatory must sign and date this section to confirm that identification has been validated. PART I PAYMENT FOR REGISTRATION The cost for initial registration is 150 this includes the Registration of the Lead Signatory. The cost of Registration for additional Countersignatories is 10. There is no charge for Registration Body Modification, Countersignatory Modification or Countersignatory removals I1 I2 Method of Payment for Registration - you must mark (x) one box only. If paying by cheque please insert the cheque number. Please make cheques payable to AccessNI. If paying by card please complete I3-I9.


QUICK GUIDE FOR COMPLETING: BASIC DISCLOSURE APPLICATION FORMPlease complete this Application Form in CAPITAL LETTERS, using black ink. Applicants must complete Parts B, C, D, E and F (G and I if you are an individual applying for the Disclosure) and return the Form to the Responsible Body for completion of Part A, H, I and J. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed.

PART A TYPE OF APPLICATIONIndicate the type of Disclosure being requested by marking X in the appropriate box. A1 A2 A3 A4 This Box is pre-completed Enter Responsible Body Name Enter 10 digit Responsible Body Number Enter 10 digit Countersignatory Number (this should not be completed until after the Applicant has completed their details onto the Form

}

Responsible Bodies Only


B9 Date of Birth - enter the day, month and year you were born in the format DD/MM/ YYYY - e.g. 04/03/1960. B10 Place of Birth - enter the name of the town and the country where you were born. B11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. B12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). B13 Do you hold a valid passport? - if no, go to B17, if yes, you must complete B14, B15 and B16. B14 Passport number - enter passport number. The passport should be valid. B15 Nationality - enter your nationality as indicated on your passport. B16 Country of issue - enter the country your passport was issued in. B17 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary.

PART C - APPLICANTS CURRENT AND DELIVERY ADDRESSC1-C6 Current Address - please note that this will be the delivery address of the Disclosure Certificate. It should be your home address or, where this is not possible, Halls of Residence or temporary lodgings. Also include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at C6. If the date is within the last 5 years you must complete additional addresses to cover the full 5 years in Part D. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. C7 C11 Delivery Address (if different) - this is the address to which you would prefer AccessNI to forward the Disclosure Certificate to. If it is the same as your current please leave blank.

PART D - ADDRESS HISTORYD1-D12 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet. pdf.

PART E - NAMES HISTORYOnly applies if you have any previous surnames or forenames not recorded in Part B6 and B7. This should be completed if you have answered yes to B6 or B7. There must be no gaps in the dates; overlapping dates are acceptable. E1-E4 - Insert any additional surnames used, and dates. E5-E8 - Insert any additional forenames used, and dates. If necessary, please use an additional page, clearly writing your current name and date of birth at the top of the page.

PART F DECLARATION BY APPLICANTPlease read this section carefully as it is where you declare that all the information provided is correct and up to date and where you are informed that AccessNI will use the information supplied to verify your identity against information held on Police and Government data bases. If necessary information provided may be used to update or perfect records already held within such data bases. In addition AccessNI may pass the information provided on this form to Police, Government Organisations and law enforcement agencies for the purposes of the protection and detection of crime. All Sharing of information with be in accordance with section 29 of the Data Protection Act 1998 and AccessNIs Information Charter (see guidance on website for this.http://www. dojni.gov.uk/index/accessni/about-ani/accessni_information_charter_-_sept_2012.pdf). F1 Signature of Applicant - place your signature ensuring it stays within the box provided. F2 Date of Signature. F3 Insert your name in capitals.

PART G BASIC DISCLOSURE IDENTIFICATION CHECKPart G should only be completed if the Applicant is processing the application themselves (and not through a Responsible Body). The Applicant should take this form, along with appropriate ID documents (see guidance on website for this http://www.dojni.gov.uk/ index/accessni/applicationforms/ id-validation-form.pdf) to a PSNI station where identity will be verified and Form completed accordingly. The PSNI stamp must be dated within the last 3 months.

PART H RESPONSIBLE BODY INFORMATION [ONLY]H1 Position applied for - this will not appear on the Disclosure Certificate. H2 Organisation name - this will not appear on the Disclosure Certificate. H3 Have you established the true identity of the applicant by examining a range of documents as set out in AccessNI guidance, and verified the information provided in Parts B, C, D AND E? - this box must be ticked yes or the form will be returned unprocessed. H4 Application Type - please indicate if the post is for an New Post Holder, Existing Post Holder, Re Check of existing post holder. H5 Your reference number - if you require a number which you would like to appear on the certificate please enter it here i.e. an internal recruitment code.

PART I PAYMENTPlease select appropriate method of payment. Applications through Responsible Bodies must be ON ACCOUNT.

PART J RESPONSIBLE BODY DECLARATION [RESPONSIBLE BODIES ONLY]Please read the declaration and sign. This is the Responsible Body statement that all documentation has been supplied and checked in accordance with AccessNI guidance. J1 J2 J3 Signature of Registered Person - This must be an original signature. Date of signature - must always be within 3 months from the date received by AccessNI. Name in CAPITALS.


QUICK GUIDE FOR COMPLETING: STANDARD DISCLOSURE APPLICATION FORMPlease complete this Application Form in CAPITAL LETTERS, using black ink. Applicants must complete Parts B, D, E, F and G and return the Form to the Registered Body for completion of Part A, H, I and J. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed.

PART A TYPE OF APPLICATIONIndicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. A1 A2 A3 A4 Please indicate which disclosure you are requesting, X one box only Enter Registered Body Name Enter 10 digit Registered Body Number Enter 10 digit Countersignatory Number (this should not be completed until after the Applicant has completed their details onto the Form)


B9 Date of Birth - enter the day, month and year you were born in the format DD/MM/ YYYY - e.g. 04/03/1960. B10 Place of Birth - enter the name of the town and the country where you were born. B11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. B12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). B13 Do you hold a valid passport? - if no, go to B17, if yes, you must complete B14, B15 and B16. B14 Passport number - enter passport number. The passport should be valid. B15 Nationality - enter your nationality as indicated on your passport. B16 Country of issue - enter the country your passport was issued in. B17 Do you have an ISA registration number - Do not complete. B18 ISA Registration number- Do not complete. B19 Do you have a Scottish Vetting & Barring number - Do not complete. B20 Scottish Vetting and Barring Number - Do not complete. B21 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary.

PART D - APPLICANTS CURRENT AND DELIVERY ADDRESSD1-D6 Current Address - please note that this will be the delivery address of the Disclosure Certificate. It should be your home address or, where this is not possible, Halls of Residence or temporary lodgings. Also include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D6. If the date is within the last 5 years you must complete additional addresses to cover the full 5 years in Part E. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. D7 D11 Delivery Address (if different) - this is the address to which you would prefer AccessNI to forward the Disclosure Certificate to. If it is the same as your current please leave blank.

PART E - ADDRESS HISTORYE1-E12 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni. gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf.

PART F - NAMES HISTORYOnly applies if you have any previous surnames or forenames not recorded in Part B6 and B7. This should be completed if you have answered yes to B6 or B7. There must be no gaps in the dates; overlapping dates are acceptable. F1-F4 - Insert any additional surnames used, and dates. F5-F8 - Insert any additional forenames used, and dates. If necessary, please use an additional page, clearly writing your current name and date of birth at the top of the page.

PART G DECLARATION BY APPLICANTPlease read this section carefully as it is where you declare that all the information provided is correct and up to date and where you are informed that AccessNI will use the information supplied to verify your identity against information held on Police and Government data bases. If necessary information provided may be used to update or perfect records already held within such data bases. In addition AccessNI may pass the information provided on this form to Police, Government Organisations and law enforcement agencies for the purposes of the protection and detection of crime. All Sharing of information with be in accordance with section 29 of the Data Protection Act 1998 and AccessNIs Information Charter (see guidance on website for this http://www. dojni.gov.uk/index/accessni/about-ani/accessni_information_charter_-_sept_2012.pdf). G1 G2 G3 G4 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. Signature of Applicant - place your signature ensuring it stays within the box provided. Date of Signature. Insert your name in CAPITALS.

PART H REGISTERED BODY INFORMATIONH1 H2 Is the applicant applying for an AccessNI disclosure - must be Yes. Position applied for - please ensure the position applied contains clear evidence for the request. It must be obvious the position qualifies for an standard disclosure. H3 Organisation name - the description you enter here will be recorded on the certificate H4 Will the work be carried out at the home of the applicant? - one box must be X. H5 Is the disclosure required for the purpose of asking an exempted question? Standard Disclosures can only be provided if the position applied for H2 is exempt from the provisions of set out in the Rehabilitation of Offenders (Northern Ireland) Order 1978 - it is the responsibility of the Counter Signatory to ensure this is the case. If No, is marked with X then the form will be returned unprocessed. H6 Is the disclosure required for a prescribed purpose - this must be X No. If you are unsure a list of prescribed purposes can be viewed on our website. H7 Does this position require a check of the Childrens Barred List (Regulated Activity) this must be X No. Standard disclosures do not contain a check of the barred lists. H8 Does this position require a check of the Vulnerable Adults Barred List (Regulated Activity) this must be X No. Standard disclosures do not contain a check of the barred lists. H9 Have you established the true identity of the applicant by examining a range of documents as set out in AccessNI guidance, and verified the information provided in Parts B, D, E & F. This box must be X Yes or the form will be returned. H10 Application Type - please indicate if the post is for an New Post Holder, Existing Post Holder, Re Check of existing post holder. H11 Your reference number. If you require a number which you would like to appear on the certificate please enter it here i.e. an internal recruitment code. Do not use Countersignatory number.

PART I PAYMENTI1 Please X the appropriate box. Account Invoices will issue at the beginning of each month and will include charges for Disclosure Certificates issued during the previous month. Acceptable payment methods can be found on page 1 of the invoice. No Payment (Volunteer) Access NI will provide free disclosure services to volunteers who meet the AccessNI definition. Further details can be found on http://www.dojni.gov.uk/index/accessni/whouses-ani/volunteers.htm.

PART J DECLARATIONPlease read the declaration and sign. This is the Registered Body statement that all documentation has been supplied and checked in accordance with AccessNI guidance. J1 J2 J3 Signature of Registered Person - this must be an original signature. Date of signature - must always be within 3 months from the date received by AccessNI. Name in CAPITALS


QUICK GUIDE FOR COMPLETING: MODIFY LEAD/COUNTERSIGNATORY DETAILSThe Modify Lead Signatory Details must be completed by the Lead Signatory who should insert the appropriate amendments. Please complete this form using black ink only and CAPITAL letters. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed. PART A TYPE OF APPLICATION Indicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. A1 Initial Registration A2 Modify Registration details A3 Add Countersignatory A4 Modify Lead Countersignatory Signatory Number A5 Remove Lead / Countersignatory A6 Change Designated Lead Signatory PART B ORGANISATION DETAILS B1 Registered Body Number - this does not need to be completed for initial registration but for all other modifications this section must be completed with the Registered Bodys reference number which was provided by AccessNI. B2 Organisation name - this is the name of your organisation B3 Umbrella body - mark the box if you will be acting as an Umbrella body for other organisations for the purpose of countersigning Standard and Enhanced Disclosure Applications and/or ISA Registration Applications. B4 and B5 Regulated / Controlled activities - one or both these must be marked if the organisation is entitled to ask the exempted question (refer to the Safeguarding Vulnerable Groups (NI) Order 2007 for clarification on definitions or contact the ISA helpline on 0300123 1111. B6 This organisation is classed as non-profit making and non-statutory. It is essential that AccessNI is informed of the organisations status in this respect. One box must be X. B7-B11 Office Address - this is the address where any correspondence from AccessNI will be sent. B12 Organisation Telephone Number - enter the Registered Bodys telephone number with the STD code at which AccessNI will be able to contact a Countersignatory if necessary. Please note that if this is left blank it could result in delaying processing your registration. Do not leave any spaces when entering the number.

B13 Fax Number - enter the Registered Bodys fax number with the STD. Do not leave any spaces when entering the number. B14 Organisation Website Address - please insert your organisations website address B15 Purpose of the organisation - this should be a summary of the aims and objectives of the organisation. Additional pages may be used if necessary. B16 Charity/Company number - this is the unique Charity/Company number of your organisation - if applicable. B17 Exempted Questions - this is the confirmation that the organisation will be asking exempted questions. It is important that the organisation thoroughly check they have an entitlement to ask this question. B18 Part V of the Police Act - this is the confirmation the organisation is likely to countersign Disclosure Applications under Section 113A and/or 113B of Part V of the Police Act 1997 at the request of bodies or individuals asking the exempted questions (Umbrella Bodies only). B19 Code of Practice - this is the declaration that the organisation will comply with AccessNIs Code of Practice and will address issues raised by AccessNI to ensure adherence to its policies. This box must be marked to enable AccessNI to proceed with the registration. Details of the Code of Practice and the Explanatory Guide can be found at http://www.dojni.gov.uk/index/accessni/support/code-of-practice.htm. B20 Number of Disclosures - please estimate the number of each type of service listed the organisation is likely to countersign per year. PART C - PROPOSED METHOD OF PAYMENT FOR DISCLOSURE APPLICATIONS C1 Please indicate here if Standard or Enhanced Disclosure Applications or ISA Registrations will be paid for. You must X one box. C2 If you have answered yes above please indicate the proposed method of payment. PART D LEAD / COUNTERSIGNATORY DETAILS D1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. D2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. D3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. D4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. D5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc. D6 Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes, please insert names and dates. D7 Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes please insert names and dates. D8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice.

Date of Birth - enter the day, month and year you were born in the format DD/MM/YYYY - e.g. 04/03/1960. D10 Place of Birth - enter the name of the town and the country where you were born. D11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. D12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). D13 Do you hold a valid passport? - if no, go to D17, if yes, you must complete D14, D15 and D16. D14 Passport number - enter Passport number. The passport should be valid. D15 Nationality - enter your nationality as indicated on your passport. D16 Country of issue - enter the Country your passport was issued in. D17 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary. D18 Business E-mail Address - enter the email address you wish to be contacted on. D19-D24 Current Address - include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D24. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your form will be returned unprocessed. D25-D36 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf PART E DECLARATION BY APPLICATION Please read this section carefully as it is where you declare that all the information provided is correct and up to date. You must provide your signature and ensure that you print your full name and enter the date on this section of the form. E2 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. E3 Signature of Applicant - place your signature ensuring it stays within the box provided. By signing the box below you are agreeing to the above conditions of Registration. E4 Date of Signature. E5 Insert your name in capitals. PART F VERIFICATION OF IDENTITY Please see the Guidance Notes or AccessNI website for acceptable means of identification. Photocopies of identification documents must be included with the registration form when applying. Do not send original Identification Documents F1 Please X this box to indicate the appropriate documentation has been submitted.

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PART G DECLARATION This is the declaration that you can ask an exempted question under the terms of The Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 and that the checks requested are in accordance with the relevant sections of Part V of the Police Act 1997. The proposed Lead Signatory must sign and date this section. G1 Signature of Applicant - place your signature ensuring it stays within the box provided. G2 Date of Signature. By signing the box below you are agreeing to the above conditions of Registration. PART H AUTHORISATION Do not complete this section for Initial Registration. H1 H2 This is the name and reference number of the Lead Signatory in the organisation who will approve countersignatories and validate identity. H3 Please X this box to confirm the identity of the proposed Countersignatory has been checked in line with the AccessNI identification documents. H4 This Lead Signatory must X this box to confirm the information and changes requested are necessary to maintain an accurate and up-to-date AccessNI registration for the Registered Body. H5 H6 The Lead Signatory must sign and date this section to confirm that identification has been validated. PART I PAYMENT FOR REGISTRATION The cost for initial registration is 150 this includes the Registration of the Lead Signatory. The cost of Registration for additional Countersignatories is 10. There is no charge for Registration Body Modification, Countersignatory Modification or Countersignatory removals. I1 I2 Method of Payment for Registration - you must mark (x) one box only. If paying by cheque please insert the cheque number. Please make cheques payable to AccessNI. If paying by card please complete I3-I9.


QUICK GUIDE FOR COMPLETING: MODIFY REGISTRATION DETAILSThe Modify Registration Details must be completed by the Lead Signatory who should insert the appropriate amendments. Please complete this form using black ink only and CAPITAL letters. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed. PART A TYPE OF APPLICATION Indicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. PART B PERSONAL DETAILS A1 Initial Registration A2 Modify Registration details A3 Add Countersignatory A4 Modify Lead Countersignatory A5 Remove Lead / Countersignatory A6 Change Designated Lead Signatory PART B ORGANISATION DETAILS B1 Registered Body Number - this does not need to be completed for initial registration but for all other modifications this section must be completed with the Registered Bodys reference number which was provided by AccessNI. B2 Organisation name - this is the name of your organisation. B3 Umbrella body - mark the box if you will be acting as an Umbrella body for other organisations for the purpose of countersigning Standard and Enhanced Disclosure Applications and/or ISA Registration Applications. B4 and B5 Regulated / Controlled activities - one or both these must be marked if the organisation is entitled to ask the exempted question (refer to the Safeguarding Vulnerable Groups (NI) Order 2007 for clarification on definitions or contact the ISA helpline on 0300123 1111. B6 This organisation is classed as non-profit making and non-statutory. It is essential that AccessNI is informed of the organisations status in this respect. One box must be X. B7-B11 Office Address - this is the address where any correspondence from AccessNI will be sent.

B12 Organisation Telephone Number - enter the Registered Bodys telephone number with the STD code at which AccessNI will be able to contact a Countersignatory if necessary. Please note that if this is left blank it could result in delaying processing your registration. Do not leave any spaces when entering the number. B13 Fax Number - enter the Registered Bodys fax number with the STD. Do not leave any spaces when entering the number. B14 Organisation Website Address - please insert your organisations website address. B15 Purpose of the organisation - this should be a summary of the aims and objectives of the organisation. Additional pages may be used if necessary. B16 Charity/Company number - this is the unique Charity/Company number of your organisation - if applicable. B17 Exempted Questions - this is the confirmation that the organisation will be asking exempted questions. It is important that the organisation thoroughly check they have an entitlement to ask this question. B18 Part V of the Police Act - this is the confirmation the organisation is likely to countersign Disclosure Applications under Section 113A and/or 113B of Part V of the Police Act 1997 at the request of bodies or individuals asking the exempted questions (Umbrella Bodies only). B19 Code of Practice - this is the declaration that the organisation will comply with AccessNIs Code of Practice and will address issues raised by AccessNI to ensure adherence to its policies. This box must be marked to enable AccessNI to proceed with the registration. Details of the Code of Practice and the Explanatory Guide can be found at http://www.dojni.gov.uk/index/accessni/support/code-of-practice.htm. B20 Number of Disclosures - please estimate the number of each type of service listed the organisation is likely to countersign per year. PART C - PROPOSED METHOD OF PAYMENT FOR DISCLOSURE APPLICATIONS C1 Please indicate here if Standard or Enhanced Disclosure Applications or ISA Registrations will be paid for. You must X one box. C2 If you have answered yes above please indicate the proposed method of payment. PART D LEAD / COUNTERSIGNATORY DETAILS D1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. D2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. D3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. D4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. D5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc. D6 Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes, please insert names and dates.

Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes, please insert names and dates. D8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice. D9 Date of Birth - enter the day, month and year you were born in the format DD/MM/YYYY - e.g. 04/03/1960. D10 Place of Birth - enter the name of the town and the country where you were born. D11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. D12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). D13 Do you hold a valid passport? - if no, go to D17, if yes, you must complete D14, D15 and D16. D14 Passport number - enter Passport number. The passport should be valid. D15 Nationality - enter your nationality as indicated on your passport. D16 Country of issue - enter the country your passport was issued in. D17 Preferred contact number enter the number you would prefer AccessNI to contact you on if necessary. D18 Business E-mail Address - enter the email address you wish to be contacted on D19-D24 Current Address - include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D24. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. D25-D36 Previous Address(es) - If you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf. PART E DECLARATION BY APPLICATION Please read this section carefully as it is where you declare that all the information provided is correct and up to date. You must provide your signature and ensure that you print your full name and enter the date on this section of the form. E2 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. E3 Signature of Applicant - place your signature ensuring it stays within the box provided. By signing the box below you are agreeing to the above conditions of Registration. E4 Date of Signature. E5 Insert your name in capitals.

D7

PART F VERIFICATION OF IDENTITY Please see the Guidance Notes or AccessNI website for acceptable means of identification. Photocopies of identification documents must be included with the registration form when applying. Do not send original Identification Documents. F1 Please X this box to indicate the appropriate documentation has been submitted.

PART G DECLARATION This is the declaration that you can ask an exempted question under the terms of The Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 and that the checks requested are in accordance with the relevant sections of Part V of the Police Act 1997. The proposed Lead Signatory must sign and date this section. G1 Signature of Applicant - place your signature ensuring it stays within the box provided. G2 Date of Signature. By signing the box below you are agreeing to the above conditions of Registration. PART H AUTHORISATION Do not complete this section for Initial Registration H1 H2 This is the name and reference number of the Lead Signatory in the organisation who will approve countersignatories and validate identity. H3 Please X this box to confirm the identity of the proposed Countersignatory has been checked in line with the AccessNI identification documents. H4 This Lead Signatory must X this box to confirm the information and changes requested are necessary to maintain an accurate and up-to-date AccessNI registration for the Registered Body. H5 H6 The Lead Signatory must sign and date this section to confirm that identification has been validated. PART I PAYMENT FOR REGISTRATION The cost for initial registration is 150 this includes the Registration of the Lead Signatory. The cost of Registration for additional Countersignatories is 10. There is no charge for Registration Body Modification, Countersignatory Modification or Countersignatory removals. I1 I2 Method of Payment for Registration - you must mark (x) one box only. If paying by cheque please insert the cheque number. Please make cheques payable to AccessNI. If paying by card please complete I3-I9.


QUICK GUIDE FOR COMPLETING: REMOVE LEAD/COUNTERSIGNATORYThis can be completed by either the Countersignatory to be removed or the Lead who should insert the appropriate amendments. Please complete this form using black ink only and CAPITAL letters. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed. PART A TYPE OF APPLICATION Indicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. A1 A2 A3 A4 A5 A6 Initial Registration Modify Registration details Add Countersignatory Modify Lead Countersignatory Remove Lead / Countersignatory Number Insert the signatory number you wish to remove Change Designated Lead Signatory

PART B ORGANISATION DETAILS B1 Registered Body Number this does not need to be completed for initial registration but for all other modifications this section must be completed with the Registered Bodys reference number which was provided by AccessNI. B2 Organisation name - this is the name of your organisation B3 Umbrella body - mark the box if you will be acting as an Umbrella body for other organisations for the purpose of countersigning Standard and Enhanced Disclosure Applications and/or ISA Registration Applications. B4 and B5 Regulated / Controlled activities - one or both these must be marked if the organisation is entitled to ask the exempted question (refer to the Safeguarding Vulnerable Groups (NI) Order 2007 for clarification on definitions or contact the ISA helpline on 0300123 1111. B6 This organisation is classed as non-profit making and non-statutory. It is essential that AccessNI is informed of the organisations status in this respect. One box must be X. B7-B11 Office Address - this is the address where any correspondence from AccessNI will be sent.

B12 Organisation Telephone Number - enter the Registered Bodys telephone number with the STD code at which AccessNI will be able to contact a Countersignatory if necessary. Please note that if this is left blank it could result in delaying processing your registration. Do not leave any spaces when entering the number. B13 Fax Number - enter the Registered Bodys fax number with the STD. Do not leave any spaces when entering the number. B14 Organisation Website Address - please insert your website address. B15 Purpose of the organisation - this should be a summary of the aims and objectives of the organisation. Additional pages may be used if necessary. B16 Charity/Company number this is the unique Charity/Company number of your organisation - if applicable. B17 Exempted Questions - this is the confirmation that the organisation will be asking exempted questions. It is important that the organisation thoroughly check they have an entitlement to ask this question. B18 Part V of the Police Act - this is the confirmation the organisation is likely to countersign Disclosure Applications under Section 113A and/or 113B of Part V of the Police Act 1997 at the request of bodies or individuals asking the exempted questions (Umbrella Bodies only). B19 Code of Practice - this is the declaration that the organisation will comply with AccessNIs Code of Practice and will address issues raised by AccessNI to ensure adherence to its policies. This box must be marked to enable AccessNI to proceed with the registration. Details of the Code of Practice and the Explanatory Guide can be found at http://www.dojni.gov.uk/index/accessni/support/code-of-practice.htm. B20 Number of Disclosures - please estimate the number of each type of service listed the organisation is likely to countersign per year. PART C - PROPOSED METHOD OF PAYMENT FOR DISCLOSURE APPLICATIONS C1 Please indicate here if Standard or Enhanced Disclosure Applications or ISA Registrations will be paid for. You must X one box. C2 If you have answered yes above please indicate the proposed method of payment. PART D LEAD / COUNTERSIGNATORY DETAILS D1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. D2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. D3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. D4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. D5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc. D6 Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes please insert names and dates.

Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes, please insert names and dates. D8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice. D9 Date of Birth - enter the day, month and year you were born in the format DD/MM/YYYY - e.g. 04/03/1960. D10 Place of Birth - enter the name of the town and the country where you were born. D11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. D12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). D13 Do you hold a valid passport? - if no, go to D17, if yes, you must complete D14, D15 and D16. D14 Passport number - enter Passport number. The passport should be valid. D15 Nationality - enter your nationality as indicated on your passport. D16 Country of issue - enter the country your passport was issued in. D17 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary. D18 Business E-mail Address - enter the email address you wish to be contacted on. D19-D24 Current Address - include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D24. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your form will be returned unprocessed. D25-D36 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf. PART E DECLARATION BY APPLICATION Please read this section carefully as it is where you declare that all the information provided is correct and up to date. You must provide your signature and ensure that you print your full name and enter the date on this section of the form. E2 E3 E4 E5 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. Signature of Applicant - place your signature ensuring it stays within the box provided. By signing the box below you are agreeing to the above conditions of Registration. Date of Signature. Insert your name in capitals.

D7

PART F VERIFICATION OF IDENTITY Please see the Guidance Notes or AccessNI website for acceptable means of identification. Photocopies of identification documents must be included with the registration form when applying. Do not send original Identification Documents. F1 Please X this box to indicate the appropriate documentation has been submitted. PART G DECLARATION This is the declaration that you can ask an exempted question under the terms of The Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 and that the checks requested are in accordance with the relevant sections of Part V of the Police Act 1997.The proposed Lead Signatory must sign and date this section. G1 Signature of Applicant - place your signature ensuring it stays within the box provided. G2 Date of Signature. By signing the box below you are agreeing to the above conditions of Registration. PART H AUTHORISATION Do not complete this section for Initial Registration. H1 H2 This is the name and reference number of the Lead Signatory in the organisation who will approve countersignatories and validate identity. H3 Please X this box to confirm the identity of the proposed Countersignatory has been checked in line with the AccessNI identification documents. H4 This lead Signatory must X this box to confirm the information and changes requested are necessary to maintain an accurate and up-to-date AccessNI registration for the Registered Body. H5 H6 The Lead Signatory must sign and date this section to confirm that identification has been validated. PART I PAYMENT FOR REGISTRATION The cost for initial registration is 150 this includes the Registration of the Lead Signatory. The cost of Registration for additional Countersignatories is 10. There is no charge for Registration Body Modification, Countersignatory Modification or Countersignatory removals. I1 I2 Method of Payment for Registration - you must mark (x) one box only. If paying by cheque please insert the cheque number. Please make cheques payable to AccessNI. If paying by card please complete I3-I9.


QUICK GUIDE FOR COMPLETING: CHANGE DESIGNATED LEAD SIGNATORYThis can be completed by either the Countersignatory or the Lead who should insert the appropriate amendments. Please complete this form using black ink only and CAPITAL letters. Please nominate a current signatory to become the new Lead and specify if the current lead is to be removed or changed to a Countersignatory. Please write this in the box on page 1. Text in RED indicates fields that are mandatory on the Form - failure to complete the relevant information will result in the Form being returned unprocessed. PART A TYPE OF APPLICATION Indicate the type of Disclosure being requested by marking X in the appropriate box. If you are unsure speak to your Registered Body who will advise you. A1 Initial Registration A2 Modify Registration details A3 Add Countersignatory A4 Modify Lead Countersignatory A5 Remove Lead / Countersignatory Signatory Number Insert the signatory number you wish to remove A6 Change Designated Lead Signatory PART B ORGANISATION DETAILS B1 Registered Body Number - this does not need to be completed for initial registration but for all other modifications this section must be completed with the Registered Bodys reference number which was provided by AccessNI. B2 Organisation name - this is the name of your organisation. B3 Umbrella body - mark the box if you will be acting as an Umbrella body for other organisations for the purpose of countersigning Standard and Enhanced Disclosure Applications and/or ISA Registration Applications. B4 and B5 Regulated / Controlled activities - one or both these must be marked if the organisation is entitled to ask the exempted question (refer to the Safeguarding Vulnerable Groups (NI) Order 2007 for clarification on definitions or contact the ISA helpline on 0300123 1111. B6 This organisation is classed as non-profit making and non-statutory. It is essential that AccessNI is informed of the organisations status in this respect. One box must be X.

B7-B11 Office Address - this is the address where any correspondence from AccessNI will be sent. B12 Organisation Telephone Number - enter the Registered Bodys telephone number with the STD code at which AccessNI will be able to contact a Countersignatory if necessary. Please note that if this is left blank it could result in delaying processing your registration. Do not leave any spaces when entering the number. B13 Fax Number - enter the Registered Bodys fax number with the STD. Do not leave any spaces when entering the number. B14 Organisation Website Address - please insert your organisation website address. B15 Purpose of the organisation - this should be a summary of the aims and objectives of the organisation. Additional pages may be used if necessary. B16 Charity/Company number - this is the unique Charity/Company number of your organisation - if applicable. B17 Exempted Questions - this is the confirmation that the organisation will be asking exempted questions. It is important that the organisation thoroughly check they have an entitlement to ask this question. B18 Part V of the Police Act - this is the confirmation the organisation is likely to countersign Disclosure Applications under Section 113A and/or 113B of Part V of the Police Act 1997 at the request of bodies or individuals aski.ng the exempted questions (Umbrella Bodies only). B19 Code of Practice - this is the declaration that the organisation will comply with AccessNIs Code of Practice and will address issues raised by AccessNI to ensure adherence to its policies. This box must be marked to enable AccessNI to proceed with the registration. Details of the Code of Practice and the Explanatory Guide can be found at http://www.dojni.gov.uk/index/accessni/support/code-of-practice.htm. B20 Number of Disclosures - please estimate the number of each type of service listed the organisation is likely to countersign per year. PART C - PROPOSED METHOD OF PAYMENT FOR DISCLOSURE APPLICATIONS This section should only be completed if you will be paying for Disclosure Certificates or ISA Registrations that you will be requesting from AccessNI. C1 C2 Please indicate here if Standard or Enhanced Disclosure Applications or ISA Registrations will be paid for. You must X one box. If you have answered yes above please indicate the proposed method of payment.

PART D LEAD / COUNTERSIGNATORY DETAILS D1 Title - mark X clearly in the appropriate box. Examples of other may be Reverend, Sister etc. D2 Surname - enter your current Surname or last name. This will be the name that appears on your Disclosure Certificate. D3 Forename(s) - please write your full first name not just initials. Include all your forenames if you have more than one. D4 Name usually known by - use this section to include abbreviations, nicknames, etc by which you are more commonly known. D5 Surname at birth (if different) - if your surname at birth was different from your current surname please provide details and the date during which the names were used. This would only be applicable where your surname is different from your current surname i.e. changed by marriage, deed poll, etc.

Any other surname(s) used? - one of the boxes must be completed. This applies to all other previously used surnames you have used during your lifetime e.g. previous marriages, previous deed poll changes. Please also supply dates of changes. If yes, please insert names and dates. D7 Any other forename(s) used? - one of the boxes must be completed. This applies to all previous forenames you have used during your lifetime and the dates when these names were used. If yes, please insert names and dates. D8 Gender - mark on the appropriate box. If you are transgender and do not wish your employer to know of your previous gender, please contact AccessNI for advice. D9 Date of Birth - enter the day, month and year you were born in the format DD/MM/YYYY - e.g. 04/03/1960. D10 Place of Birth - enter the name of the town and the country where you were born. D11 National Insurance Number - enter in spaces provided. This can normally be found on your payslip or any personalised Customs and Revenue Documents. D12 Driving Licence Number - enter the full Driving Licence number as found on your UK driving licence (point 5 on your driving licence refers). D13 Do you hold a valid passport? - if no, go to D17, if yes, you must complete D14, D15 and D16. D14 Passport number - enter passport number. The passport should be valid. D15 Nationality - enter your nationality as indicated on your passport. D16 Country of issue - enter the country your passport was issued in. D17 Preferred contact number - enter the number you would prefer AccessNI to contact you on if necessary. D18 Business E-mail Address - enter the email address you wish to be contacted on. D19-D24 Current Address - include the date from which you have been a resident at this address. Each section must be completed. It is essential you supply a date at D24. Please give full address details, including postcode and dates of residence. If you do not provide a full 5 year address history your Form will be returned unprocessed. D25-D36 Previous Address(es) - if you have lived at your current address for less than 5 years you will need to provide your continuous address history for the last 5 years. You should include addresses outside the UK where appropriate. There must be no gaps in the dates provided; overlapping dates are acceptable. Please give full address details, including postcode. If your address history does not fit in the spaces provided you should use the approved Address Continuation Sheet which can be downloaded at http://www.dojni.gov.uk/index/accessni/application-forms/addresscontinuationsheet.pdf. PART E DECLARATION BY APPLICATION Please read this section carefully as it is where you declare that all the information provided is correct and up to date. You must provide your signature and ensure that you print your full name and enter the date on this section of the Form. E2 Do you have any convictions - have you ever been convicted in a court of law. Place a cross in the relevant box. E3 Signature of Applicant - place your signature ensuring it stays within the box provided. By signing the box below you are agreeing to the above conditions of Registration. E4 Date of Signature. E5 Insert your name in capitals.

D6

PART F VERIFICATION OF IDENTITY Please see the Guidance Notes or AccessNI website for acceptable means of identification. Photocopies of identification documents must be included with the registration form when applying. Do not send original Identification Documents. F1 Please X this box to indicate the appropriate documentation has been submitted.

PART G DECLARATION This is the declaration that you can ask an exempted question under the terms of The Rehabilitation of Offenders (Exceptions) Order (Northern Ireland) 1979 and that the checks requested are in accordance with the relevant sections of Part V of the Police Act 1997. The proposed Lead Signatory must sign and date this section. G1 Signature of Applicant - place your signature ensuring it stays within the box provided. G2 Date of Signature. By signing the box below you are agreeing to the above conditions of Registration. PART H AUTHORISATION Do not complete this section for Initial Registration. H1 H2 This is the name and reference number of the Lead Signatory in the organisation who will approve countersignatories and validate identity. H3 Please X this box to confirm the identity of the proposed Countersignatory has been checked in line with the AccessNI identification documents. H4 The Lead Signatory must X this box to confirm the information and changes requested are necessary to maintain an accurate and up-to-date AccessNI registration for the Registered Body. H5 H6 The Lead Signatory must sign and date this section to confirm that identification has been validated. PART I PAYMENT FOR REGISTRATION The cost for initial registration is 150 this includes the Registration of the Lead Signatory. The cost of Registration for additional Countersignatories is 10. There is no charge for Registration Body Modification, Countersignatory Modification or Countersignatory removals. I1 I2 Method of Payment for Registration - you must mark (x) one box only. If paying by cheque please insert the cheque number. Please make cheques payable to AccessNI. If paying by card please complete I3-I9.

ID VALIDATION FORM

It is standard good recruitment practice for employers to satisfy themselves as to the identity of those applying for positions. Although AccessNI may in some cases conduct its own checks to confirm identity, there is no substitute for thorough identity checks by employers. Larger Registered Bodies that delegate responsibility for ID checking, or Umbrella Bodies who are assisting smaller organisations through the checking process, should ensure documentary evidence is validated, and that they indicate on the Disclosure Application Form (Part H), the checks have been made. Employers should seek to comply with the Guidance below. Organisations must also ensure they comply with Section 3 of the AccessNI Code of Practice.

Valid Identification DocumentsThree documents must be produced in the name of the applicant; one from Group 1 and two from Group 2 (see overleaf). If this is not possible, then five documents from Group 2 must be produced. It is preferred that at least one of these documents includes photographic identification. Please use the attached form and tick the appropriate boxes to indicate what ID has been checked. Approved Counter Signatories must ensure that H9 of the Disclosure Application Form is completed. This ID Validation Form should be made available to AccessNI on request.

Name of applicant_________________________________ Date ID check carried out: ID checked by: ________________________

_________________________________

I confirm I have seen the original ID documents as indicated on the attached sheet

Signed:__________________________________________

THIS FORM SHOULD BE RETAINED WITHIN YOUR ORGANISATION. PLEASE DO NOT SEND IT TO ACCESSNI

THIS FORM HAS BEEN CREATED TO ASSIST YOUR ORGANISATION WITH ROBUST ID CHECKS

GROUP 1Valid Passport UK Driving Licence Full or Provisional England/Wales/Scotland/Northern Ireland/Isle of Man; either photocard or paper (a Photocard is only valid if accompanied with the paper counterpart) Original UK birth certificate (issued within 12 months of date of birth, full or short form acceptable) Valid photo identity card (EU countries only) UK Firearms licence HM Forces ID card (UK) Adoption Certificate (UK)

GROUP 2Marriage certificate/ Civil Partnership Certificate Non-original UK birth certificate (issued after 12 months of date of birth, full or short form acceptable

P45/P60 statement

Utility bill (electricity, gas,water,telephone including mobile phone contract/bill) Valid TV licence Credit card statement Store card statement Mortgage Statement Valid insurance certificate Certificate of British nationality British work permit/visa ** Asylum Registration Card AccessNI Disclosure Certificate Personal correspondence or a document from a Government Department * Bank or Building Society Document ** Financial statement e.g. pension,endowment,ISA ** Valid vehicle registration document Mail order catalogue statement* Court summons Valid NHS card Court Claim Form Addressed payslip* National insurance number card Examination certificate (e.g. GCSE, NVQ) Letter from a Head Teacher* Child Benefit book Smartpass

* documentation must be less than 3 months old ** documentation must be issued within the last 12 months

THIS FORM HAS BEEN CREATED TO ASSIST YOUR ORGANISATION WITH ROBUST ID CHECKS

Names history continuation sheetIf necessary, this sheet should be used in conjunction with an AccessNI Disclosure Application Form. Please complete the details at Part A and add [at Part B or Part C] the remaining names for which there was insufficient room on the Disclosure Application Form. Please ensure you sign and date this sheet at Part D.

PART A

Applicants details

A1 Current surname A2 Current forename(s) A3 Date of birth

D D / M M / Y Y Y Y

PART B

Previous surname(s) (continued)

B1 Previous surname B2 Date used from B3 Previous surname B4 Date used from B5 Previous surname B6 Date used from

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

PART C

Previous forename(s) (continued)

C1 Previous forename C2 Date used from C3 Previous forename C4 Date used from C5 Previous forename C6 Date used from

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

D D / M M / Y Y Y Y

to

D D / M M / Y Y Y Y

PART D

Applicants signatureD2 Date of Signature

D1 Signature of Applicant (please sign in box)

D D / M M / Y Y Y Y

Monday 29 March 2010

Volume 508 No. 65

HOUSE OF COMMONSOFFICIAL REPORT

PARLIAMENTARY DEBATES(HANSARD)Monday 29 March 2010

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Parliamentary Copyright House of Commons 2010 This publication may be reproduced under the terms of the Parliamentary Click-Use Licence, available online through the Office of Public Sector Information website at www.opsi.gov.uk/click-use/ Enquiries to the Office of Public Sector Information, Kew, Richmond, Surrey TW9 4DU; e-mail: [email protected]

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House of CommonsMonday 29 March 2010 The House met at half-past Two oclock PRAYERS [MR. SPEAKER in the Chair]

Hon. Members: Wake up. The Secretary of State for Defence (Mr. Bob Ainsworth): My apologies: I think the problem is deafness rather than sleep. As General McChrystal has said, the situation in Afghanistan is serious, but it is no longer deteriorating, and the international effort will make real progress this year. Already Afghan forces and ISAFthe international security assistance forcehave successfully delivered improved security to the population of central Helmand through Operation Moshtarak. Working closely with our Afghan allies, the international communitys next step will be to strengthen governance and security in Kandahar city. Mr. Jones: Security in Helmand province has for years been the responsibility of British forces, many of whom have lost their lives in the process. What effect does the Secretary of State think it would have on our forces in Helmand if they were to be told, as has been suggested in The Sunday Telegraph, that they are shortly to be replaced by United States marines? Mr. Ainsworth: There has been a substantial increase in forces going into Helmand. Some of those have been ourswe have increased our forces in Afghanistan by about 1,200 in a yearbut the biggest single inflow has been from the United States of America. We have been very happy to work alongside US forces, and they now operate in the south of Helmand provincewe very recently handed over Musa Qala to them. What we are involved in is a coalition effort: we have to work alongside our coalition partners, and that does not mean just the United States of America. In Helmand we have Danes and Estonians working in our area of operation alongside our forces, as well as those of the Afghans of course, so I do not think that there is a problem among our armed forces in recognising the need to work with others. Ms Dari Taylor (Stockton, South) (Lab): Concern has been expressed about the impact of Taliban and al-Qaeda training camps in the North West Frontier province of Pakistan. Can my right hon. Friend say what assessment has been made of those camps, how effective they are, and to what extent the Americans now have a controlling impact on them, so that they cannot undermine the work being done by NATO and UK troops in Afghanistan? Mr. Ainsworth: The overwhelming improvement that we have seen on the Pakistan side of the border over the past year or so has come about as a result of the efforts of the Pakistani Government and the Pakistani armed forces. Those forces have suffered great losses in some of the operations that they have conducted against insurgents in the FATAthe federally administered tribal areaand Waziristan. Those forces are bearing down on the insurgency on their side of the border, and we should recognise that and congratulate them. Of course we work with the Pakistani Government, as do the American Government and American forces. Sir Menzies Campbell (North-East Fife) (LD): But in his carefully crafted answer, the Secretary of State declined to deal with the point that was raised a moment or two ago. Is there a proposal that British forces should be withdrawn from Helmand? Yes or no?

Oral Answers to QuestionsDEFENCE The Secretary of State was asked Compensation (Shoeburyness) 1. Mr. Douglas Carswell (Harwich) (Con): What representations he has received on provision of compensation to people whose properties have been [324443] damaged by explosions at Shoeburyness. The Parliamentary Under-Secretary of State for Defence (Mr. Kevan Jones): The work at Shoeburyness is directly linked to saving the lives of service personnel on operations in Afghanistan, providing, among other things, essential pre-deployment training in the safe and controlled disposal of improvised explosive devices and similar ordnance. In 2009, I received three representations, with a further two so far this year, from people claiming that their properties had been damaged by noise and vibrations caused by activities at MOD Shoeburyness. Mr. Carswell: Everyone accepts that our armed forces need to train at Shoeburyness. However, many of the explosions are caused not by our armed forces training, but by commercial waste disposal from which big corporate interests profit. Will the Minister give an undertaking for full transparency, so that local people are made aware of which explosions are being caused in the interests of our armed forces and which in the interests of crony capitalists? Mr. Jones: I know that the hon. Gentleman is not a great supporter of our defence industries in this country, but let me tell him that the amount of ordnance exploded at Shoeburyness that is not related to trainingthis is, the d