International Child

Protection Certificate
(ICPC)
Application form
Version 3.0

The International Child Protection Certificate is used to ensure the safeguarding of children in schools/other
organisations outside the UK. It provides information to those organisations who currently do not have a
route to determine a person’s suitability to be in contact with children. It should not be considered an
alternative to an Enhanced Disclosure from the Disclosure and Barring Service (or check from another
disclosure service). Where an organisation has access to such a disclosure scheme there is no requirement to
obtain an International Child Protection Certificate. Please check that an International Child Protection
Certificate will be accepted as the validity of this document is at the discretion of the organisation.

This certificate will disclose details of any convictions, impending prosecutions, cautions, reprimands,
absolute/conditional discharges, warnings, and current investigations you may have in accordance with the
ACRO step-down model (see terms and conditions) as well as results of intelligence checks. Any intelligence
disclosed is deemed relevant for disclosure by the Chief Constable of the associated police force. By
submitting this application you are agreeing to checks on UK police databases and for relevant disclosure.

Note: only use the latest version of the application form which can be accessed via the ACRO website at
www.acro.police.uk. Your application may be delayed if you use an older version of the form.

Payment
Standard service - £75.00 - 10 working days to process (Saturday, Sunday and UK bank holidays are not working days)
The day the application is received and the day the certificate is sent out is not included in the 10
processing days. Please also allow reasonable time for delivery of certificate.

The payment covers the processing of the certificate and standard return postage, either first class Royal
Mail or standard airmail for international post. Please allow extra time if the application is made near, or
during public holidays.

Please be advised that your application may be subject to significant delays if searches of other police/law
enforcement databases are required, or if you are subject to an impending prosecution. Failure to disclose
previous arrests, cautions etc. could also lead to significant delays. If this is the case we are unable to
provide timescales for the release of your certificate.

We advise that you DO NOT arrange travel or accommodation until you have received your certificate. ACRO
cannot be held liable for any costs associated with any failure to meet such plans or losses incurred should
there be a delay with your certificate.

Additional services available:

Royal Mail UK next day delivery - £9.00
Secure international delivery - £9.00
International Courier Delivery - £48.00

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Supporting documents
The following documents are required to process your application. Do not send original documents as these
will not be returned.

1. Fully completed application form. Ensure all sections are completed in BLOCK CAPITALS and in black ink.
Fields that are not applicable should be marked N/A. Original signatures are required throughout.

2. Proof of your current address. You must provide ONE proof of your current address from the ‘Proof of
current address’ list at the end of the application form. Your current address is where you live now and
can be outside of the UK. Any proof of address that is not in English must be translated into English. The
UK driving licence paper counterpart is not an acceptable proof of address, even if it shows your current
address.

3. Copy of your offer of employment / registration with / contract from the stated organisation. The
organisation name will appear on your certificate, therefore the documentation from the organisation
should be identical to that stated on the application. Your application will be delayed if there are any
discrepancies.

4. Colour copies of your passport(s) / travel document / other official photographic identity document.
You must provide colour copies of your passport(s) / travel document which clearly show your
photograph, personal information, expiry date, nationality, machine readable zone, extension pages and
signature (if applicable). Copies of other official photographic identity documents should show as many
of these features as possible. We will not accept black and white copies.

5. ONE recent colour passport style photo (approximately 45mm x 35mm).

(PLEASE NOTE THIS PHOTO WILL APPEAR ON YOUR CERTIFICATE)
Guidance for acceptable photographs:
Your photo must:
 be a close-up of your full head and upper shoulders
 contain no other objects or people
 be in clear contrast to the background
In your photo, you must:
 be facing forward and looking straight at the camera
 have your eyes open, visible and free from reflection or glare from glasses
 not have hair in front of your eyes
 not have a head covering (unless for religious or medical reasons)
 not have anything covering your face
 not have any red eye
 not have any shadows on your face or behind you

You cannot wear sunglasses or tinted glasses. You can wear reading glasses but your eyes must show
fully through clear lenses without glare or reflections.

6. Any additional documents relevant to your application. Examples include: Power of Attorney,
authorisation documents, signed letter of authority, etc.

7. SIGNED terms and conditions.

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8. Payment.
Acceptable payment methods are UK sterling cheque, UK postal order, international bankers draft or bank
transfer. Payment must be made to ‘PCC for Hampshire’. Do not send cash. If you require a receipt, please
request one with your application.

Additional information
Please send your application and supporting documents to the appropriate address stated below:

Address for Standard Delivery: Address for Courier Delivery:

ACRO CEOP ACRO c/o CitySprint
PO Box 668 Unit 11, Solent Estate
Fareham Shamblehurst Lane
Hampshire Hedge End
PO14 9LW Southampton
(UK) SO30 2FX
(UK)

If sending your application to ACRO by a courier service, your chosen courier company must arrange for the
application to be delivered to the CitySprint address above. ACRO cannot accept responsibility for lost items
or the late or failed delivery of couriered items showing any other address.

Please apply the correct postage to your envelope otherwise your application form may not be delivered to
ACRO. Your application may be delayed if you send your documents to the wrong address for the service
you require.

If you are having difficulty completing this application, please contact ACRO Customer Services on +44(0)
2380 479920 (telephone lines are open 7.30am to 7.30pm UK time Monday to Friday excluding bank
holidays) or via email to customer.services@acro.pnn.police.uk

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ICPC application form
This application form must be completed in English using BLOCK CAPITALS and in black ink.
* = mandatory field

1 Organisation requesting the certificate

Please note that we are only able to provide an ICPC for organisations outside of the UK that you are
either already working with or have been offered a position with. The organisation will be advised to
retain the original certificate that you provide them.

1.1 *Name of school or Haileybury Almaty

organisation:
1.2 *Address of school or
112 Al Farabi Ave
organisation:
Kazakhstan
REPUBLIC OF KAZAKHSTAN

Postcode:

1.3 *Email address:

(HR Officer/point of contact –
print in UPPER CASE)
1.4 *Confirm email:
(HR Officer/point of contact –
print in UPPER CASE)
Please enclose a copy of your offer of employment / registration with / contract from the above
stated organisation. The organisation name will appear on your certificate, therefore the
documentation from the organisation should be identical to that stated above.
Your application will be delayed if there are any discrepancies

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 2 Personal information
2.1 *Title: Mr ✔ Mrs Miss Ms Other Other: (specify)
2.2 *ALL forename(s)/given name(s):
Syed Qasim Abbas
(please include all middle names)
2.3 Surname/family name: ZAIDI

2.4 *Have you ever used or been known by any other names? Yes No ✔

If you have answered ‘Yes’ to the question above, please provide a list of all your previous names
below, including maiden/married names, names prior to and after change by deed poll, and name at
birth if different from the above. Your application will be delayed if you fail to fully answer this
question. If you run out of space, please use the Additional Information page of this application form.
Forenames in Title Case and surname in UPPER CASE.
2.5 Previous/former name(s):

2.6 *Date of birth: (dd/mm/yyyy) 13/07/1991

2.7 *Place of birth: Village/town: Kingston Upon Thames
Country: ENGLAND
2.8 *Gender: Male ✔ Female Intersex

2.9 *UK National Insurance Number: JW 10 52 22 C or not applicable

2.10 UK Driving Licence Number:
(Leave blank if not applicable)
2.11 * Total duration of time spent
residing in the UK in years and 28 Years and 0 months
months:
(Please tick ‘Life’ if you have or Life
NEVER resided outside of the UK).

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 3 Passport / travel document details

3.1 *Do you have a passport or travel document?

I do not possess a passport/travel
Passport ✔ Travel document
document (see 3.16 below)
If you have ticked ‘Passport’ or ‘Travel document’ in the question above, please complete the section
below. You must enter your details exactly as shown on your passport(s)/travel document. If you have
more than two passports, please provide the details in the Additional Information section of this
application. If you do not have a current passport or travel document, please complete question 3.16
below. Please note that these details will appear on your certificate
Passport/travel document 1:
3.2 *Passport/travel document number: 124861657
3.3 Surname/family name: ZAIDI
3.4 *Forename(s)/given name(s): Syed Qasim Abbas
3.5 *Date of birth: 13/07/1991
3.6 Nationality: British
3.7 Place of birth: Kingston Upon Thames
3.8 Expiry date: (dd/mm/yyyy) 26/04/2032
Passport/travel document 2 (if applicable):
3.9 Passport/travel document number:
3.10 Surname/family name:
3.11 Forename(s)/given name(s):
3.12 Date of birth:
3.13 Nationality:
3.14 Place of birth:
3.15 Expiry date: (dd/mm/yyyy)
3.16 Do you have any other official photographic identity document?
e.g. Home Office Application Registration Card (ARC) or national identity card.
Yes No
If you have answered yes, please provide a copy with your application. If you have answered ‘No’ to
the question above, please answer question 3.17 below.
3.17 If you do not have a current passport, travel document or any other official photographic
identity document, please give the reason below.

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 4 Applicant’s contact details

4.1 *Daytime telephone number:

Please make sure that you include local/area +77013541649
and international dialling codes.
4.2 *Evening telephone number:
Please make sure that you include local/area +77013541649
and international dialling codes.
4.3 *Email address: (UPPER CASE) qasimzaidiforjob@gmail.com
4.4 *Confirm email: (UPPER CASE) qasimzaidiforjob@gmail.com

5 Address history

5.1 *Current address: This is the physical address you live at and should be shown on your proof of
address. If you cannot provide proofs of address please contact ACRO Customer Services on +44(0)
2380 479920 or by email to customer.services@acro.pnn.police.uk (Mon-Fri 7.30am-7.30pm UK time).
Please note that this address will appear on your certificate.
Current address: Date from: (mm/yyyy) 07/2022 Date to: Present

Zhamakayeva 254/2
Block Z
REPUBLIC OF KAZAKHSTAN

Postcode:
5.2 Previous addresses: If you have lived at your current address for less than 10 years, please give all
your previous address(es) for this period below, including any temporary accommodation. If you have
lived outside the UK for more than 10 years, please also provide your last UK address. If you run out of
space, please use the Additional Information page of this application form.
Previous address 1: Date from: (mm/yyyy) 09/2020 Date to: (mm/yyyy) 07/2022

Presidential Schools Of Tashkent

Uzbekistan

UZBEKISTAN

Postcode:

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 Previous address 2: Date from: (mm/yyyy) 07/1991 Date to: (mm/yyyy) 09/2020

48
Amberwood Rise
ENGLAND

Postcode: KT3 5JG

Previous address 3: Date from: (mm/yyyy) Date to: (mm/yyyy)

Postcode:
Previous address 4: Date from: (mm/yyyy) Date to: (mm/yyyy)

Postcode:
Previous address 5: Date from: (mm/yyyy) Date to: (mm/yyyy)

Postcode:

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 6 Personal history

6.1 *Have you ever lived in Scotland? Yes No ✔

6.2 *Have you ever lived in Northern Ireland? Yes No ✔

6.3 *Are you a serving, ex-serving, dependant or ex-dependant, partner

or ex-partner of a serving or ex-serving member of the UK armed forces. Yes No ✔
Are you a civilian that has been subject to UK armed forces acts?
6.4 *Are you the subject of any impending prosecutions or are you under
Yes No ✔
investigation for a criminal offence?
If you have answered ‘Yes’ to question 6.4 please provide details below. If you run out of space,
please use the Additional Information section of this application. Please note that any information
regarding impending prosecutions or criminal investigations held on police databases may show on
your certificate.
6.5 Alleged offence(s) 1:

6.6 Date of court hearing: (dd/mm/yyyy)

6.7 Court:
6.8 Additional information:

6.9 Alleged offence(s) 2:

6.10 Date of court hearing: (dd/mm/yyyy)

6.11 Court:
6.12 Additional information:

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 6.13 * In England, Wales, Northern Ireland, Scotland, Channel Islands,
Isle of Man or when serving in the UK armed forces, have you ever:
 been interviewed by police under caution; Yes No ✔
 received a postal requisition or summons;
 been arrested, cautioned, warned or reprimanded;
 received a penalty notice; or
 been convicted of a criminal offence?

You must declare ALL convictions including those you believe to be spent under the
Rehabilitation of Offenders Act 1974.
If you have answered ‘Yes’ to any of the above questions, please provide details below. If you run out
of space, please use the Additional Information section of this application.

6.14 Offence(s) 1:

6.15 Date of result/sentence/outcome: (dd/mm/yyyy)

6.16 Court:

6.17 Result/sentence/outcome (e.g. caution/imprisonment/fine):

6.18 Offence(s) 2:

6.19 Date of result/sentence/outcome: (dd/mm/yyyy)

6.20 Court:
6.21 Result/sentence/outcome (e.g. caution/imprisonment/fine):

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 7 Third party nomination

ACRO will not discuss your application or disclose your details with anyone else. However, if you
would like to nominate a third party to discuss this application on your behalf you must provide that
person’s contact details below. Providing contact details for a third party will be considered as
consent. If you are a Power of Attorney for the applicant, please enclose a copy of the Power of
Attorney documents with this application.

7.1 Name of nominated third party: Michele Gaddy

7.2 Relationship to you: Former manager
7.3 Daytime telephone number: +998906401112
7.4 Evening telephone number: +998906401112
7.5 Email address: (UPPER CASE) saltbrush2@gmail.com
7.6 Confirm email: (UPPER CASE) saltbrush2@gmail.com

8 Endorser details

Your application must be endorsed by a suitable individual that meets the following criteria:
o Must have known you for a minimum of two years
o Must not be a partner or family member (no matter how distantly related)
o Must be aged 18 years or over
o Must be in one of the occupations or a similar occupation to those listed at the
end of the application
o Must NOT be from the organisation stated in this application

This individual can be of any nationality and can reside anywhere in the world.
Please note: Your application will be delayed if you fail to provide this information.
Your endorser may be contacted to verify the authenticity of your application. As part of this
validation we may need to send the photograph you submit to confirm that it is a true likeness of
you.
8.1 *Title: Mr Mrs Miss Ms ✔ Other : (specify)
8.2 Surname/family name: GADDY
8.3 *Forename(s)/ given name(s): Michele
8.4 *Occupation: Head of International Staff - Office of the President of Uzbekistan
8.5 *Relationship to applicant: Manager
8.6 *Email address: (UPPER CASE) saltbrush2@gmail.com
8.7 *Confirm email: UPPER CASE) saltbrush2@gmail.com
8.8 Daytime telephone number: +7 701 3641649

8.9 Evening telephone number:

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 9 Additional information

9.1 Additional information: please use this page if you run out of space in any section of the
application or if you wish to provide any additional information in support of your application.

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 10 Delivery options

Postal options – the standard postal option includes first class UK mail or standard airmail. Trackable
delivery options are UK Next Day Delivery, International Tracked or International Signed For (£9.00).

International courier is not available to the UK or PO boxes (except for countries in Africa, the Middle
East and the Cayman Islands) (£48.00).

10.1 *Is your ICPC being sent to your current address? Yes ✔ No

If you have answered ‘No’ to the above question, please provide an alternative delivery address
below. This cannot be the organisation you are applying to work for.

10.2 Alternative delivery address:

10.3 Postcode:
Free
10.4 *Postal option: Trackable (£9.00) ✔ £ 9.00
Courier (£48.00)

10.5 *Service required: ICPC (£75.00) ✔ £

Sub total: £ 84.00

Please only complete this question if you are completing your application by post.
UK cheque
10.6 *Payment method: UK postal order

Payments should be made to ‘PCC for Bankers draft

Hampshire’. Bank transfer
reference number:

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Terms and conditions of service
The following terms and conditions relate to the International Child Protection Certificate (ICPC) service
provided by ACRO Criminal Records Office (ACRO) in conjunction with NCA-CEOP Command. Please read these
terms and conditions carefully. If you do not accept these terms and conditions, we will not be able to process
your application.

General:
1. You will only be provided with your certificate if you have provided the following:
• a completed application form
• ONE proof of your current address from the list at the end of the application
• colour copies of your passport(s) / travel document(s)
• a colour passport style photo
• payment
• Power of Attorney / legal documents (if applicable)
• your application must be endorsed
• a copy of your offer of employment / registration with / contract from the stated organisation
2. The provisions of the Data Protection Act mean that in certain circumstances we will not provide some
personal data. You will not be provided with personal data if:
 releasing it to you would be likely to prejudice a criminal investigation
 it identifies other individuals
 It is not relevant for your ICPC
3. Certificates are prepared in accordance with the ACRO step-down model (this model is also applied to
Northern Irish, military and overseas convictions - these are not applied to Scottish convictions). Please
note that your certificate will contain any impending prosecutions and offences that are under
investigation.
4. Your ICPC may contain intelligence information deemed relevant for disclosure by the Chief Constable of
the associated police force.
5. ACRO will not accept responsibility for ICPCs that are rejected by the relevant organisation. It is your
responsibility to check if an ICPC is acceptable to the organisation you are providing this to.
6. If you receive an ICPC that includes results of convictions and/or intelligence information, it is your choice
whether you proceed with your application to the organisation.

Your application
1. You must complete your application in English. If you fail to complete your application in English, you will
not receive your ICPC and you will not be refunded.
2. We reserve the right to request original identity documentation. Where we request original documents
they will be returned to you by registered post.
3. We reserve the right to request additional information or clarification. Your application will not be
processed without the requested information. The working days applied to the service will be suspended
until this additional information has been received.
4. If we request additional documentation, information or clarification, and you do not reply by the date
specified, we will cancel your application.
5. We aim to dispatch your ICPC within the agreed service time (10 working days, not including day of receipt
or dispatch).
6. ACRO cannot be held responsible for items lost or delayed in the post by the postal service or third party
delivery companies.
7. ACRO adheres to the Royal Mail lost in post policy and will not send any replacements free of charge until
your item is considered lost under this policy.
8. The information you provide in this application form must be accurate and it must relate to you.
9. You must declare all the names you have ever been known by.
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10. ACRO will make any enquiries deemed necessary to process your application or to verify the information
you have provided.
11. Your application may be subject to significant delays if searches of other police/law enforcement
databases are required, or if you are subject to an impending prosecution. Failure to disclose previous
arrests, cautions etc. could also lead to significant delays. If this is the case we are unable to provide
timescales for the release of the certificate and we therefore advise that you DO NOT arrange travel,
employment or accommodation plans until you have received your certificate. ACRO cannot be held liable
for any costs associated with any failure to meet such plans or losses incurred should there be a delay with
your certificate.

Your application may also be delayed if:

 You fail to complete the application form correctly.
 You do not apply the correct postage (for postal applications only).
 You do not provide the required supporting documents.
 You do not provide the correct payment.
 You are subject to any impending prosecution/outstanding investigation.
 Searches are required of historical police databases.
 Searches are required of other law enforcement databases.
 There is an unforeseen event or occurrence such as postal service restrictions, adverse weather
conditions or computer system failure.

Privacy
1. We will only contact you in relation to your ICPC if necessary, by phone, email or letter.
2. Due to the Data Protection Act 2018, ACRO will not provide you with information contained on police
systems over the telephone or by email.
3. The information you provide in your application will be used for processing your request and for any other
policing purpose.
4. The information supplied within your application and the information on the Police National Computer
(PNC) record to which your application relates may be passed to other police agencies and government
organisations in the interests of law enforcement.
5. If you impersonate or attempt to impersonate another person you may be guilty of an offence.
6. If you are an agent or principal-in-fact (i.e. you hold Power of Attorney) and are making an application on
someone else’s behalf, you must provide the Power of Attorney documents as evidence.
7. We may send the photograph you have provided in the application to your endorser to confirm that it is a
true likeness of you. Please be aware that while the email will be sent from ACRO's secure network, unless
the endorser has a secure email address, the delivery to their personal inbox is an insecure connection via
the public internet. ACRO cannot accept responsibility for any loss or inappropriate access to the email
once it has left the ACRO secure network. It is your responsibility to ensure that the email address provided
is accurate.
8. We will not discuss or provide details about your application with another party without your prior consent
unless stated in your application and with the exception of point 5 & 6 above.
9. We will securely store your personal information on our systems for 10 years.
10. We will save web cookies on your computer or device to store your data whilst you complete your online
application. The cookies will be deleted automatically when you submit your application or when your
session times out.

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Payment
1. Payment is due in full at the time of making your application.
2. First class postage of your certificate to a UK address or standard airmail to an overseas address is included
in the fee.
3. ACRO will not be held responsible for any additional charges by your bank or card issuer.
4. ACRO will not accept prepaid return envelopes or postal coupons, these will not be returned.

Cancellations and refunds:

1. If you cancel your application, or we cannot process your application because you have failed to respond
to requests for information, we will deduct an administration fee from any refund.
2. If you overpay by £10.00 or less we will not be able to refund you and will donate any remaining money
to charity.
3. If you overpay by more than £10.00, we will contact you to arrange a refund or to obtain your agreement
to donate the overpaid amount to charity. All refunds will be paid in UK pounds sterling.

Raising a concern/dispute:
1. Concerns regarding our services should be made to our Customer Services department via email to:
customer.resolutions@acro.pnn.police.uk or by letter to: ACRO, PO Box 481, Fareham, Hampshire, PO14
9FS, (UK). We will endeavour to acknowledge your concern within five working days of receipt and we will
endeavour to resolve your concern within 28 days.
2. Disputes regarding the information provided to you should be made by phone, email or letter using the
contact details above.
3. ACRO will not be held responsible for errors in records held on national police systems. If you do not agree
with the information on your certificate, ACRO will verify that the disclosure is an accurate reflection of
(a) the information you have submitted in your application, and (b) the information held on national police
systems. If you would like to dispute the information held about you on national police systems, ACRO will
refer you to the relevant data owner (usually the police force or agency that created the record).

Please indicate that you have read and agree to the terms and conditions of service.

*Applicant name: (print in UPPER CASE)

*Applicant signature: *Date: / /

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 Applicant checklist (not applicable to online applications)

This page does not need to be returned with your completed application and can be retained
for your records.
Application form (fully completed).

Signed terms and conditions of service.

One proof of your current address showing both your name and address.
A list of suitable proofs of address is at the end of the application form.

One recent colour passport style photograph.

Colour copies of passport(s) / travel document / other official photographic identity
document. Colour copies of passport(s) / travel documents must clearly show your
photograph, personal information, expiry date, nationality, machine readable zone,
extension pages and signature (if applicable). Copies of other official photographic
identity documents should show as many of these features as possible.
Black and white copies will not be accepted.

Copy of your offer of employment / registration with / contract from the stated
organisation in section 1.

Correct payment including optional postage costs if applicable (dated, signed &
payable to ‘PCC for Hampshire’).

Documents are not stapled or pinned together.

Please do not return guidance notes with your application form.

Please send your application to:

ACRO CEOP
PO Box 668
Fareham
Hampshire
PO14 9LW
(UK)

Please ensure that you apply the correct postage to your envelope otherwise your
application form may not be delivered to ACRO.

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 Application endorsement

In order to satisfy ACRO requirements, your application must be endorsed by an individual employed as
one of the following or similar professions:

Accountant Optician
Airline Pilot Personal Licence Holders (alcohol)
Ambulance Service Official / Paramedic Personnel Officer
Architect Pharmacist
Bank / Building Society Official Police Officer/Police Civilian Staff
Barrister Post Office official
Care Worker (Registered) Prison Officer
Company Chairman Probation Officer
Chemist Salvation Army Officer
Chiropodist Social Worker
Civil Servant (Permanent) Solicitor
Commissioner of Oaths Surveyor
Councillor (Local or County) Teacher
Dentist Trade Union officer
Director Tutor
Doctor Valuer or Auctioneer
Engineer Veterinarian
Executive Veterinary Nurse
Financial Adviser
Fire Service Official
Funeral Director
Insurance Broker
IT specialist
Judge
Justice of the Peace
Lawyer
Lecturer
Legal Secretary
Magistrate
Manager
Medical Consultant/Specialist
Member of a Chartered Institute
Member of Parliament
Merchant Navy Officer
Minister of a Recognised Religion
Museum Curator
Notary Public
Nurse (SRN or other qualification)
Officer of the Armed Services (Active or Retired)

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 Proof of current address

Proof of current address

You must provide one acceptable proof of your current address from either of the following lists:

One valid document that shows your name and current address.

Full driving licence/provisional driving licence

ID card from your country of residence
Medical/health Card
Immigration document

OR

One document dated within the last 12 months that shows your name and current address.

Utility bill (this does not include a mobile phone bill)

Bank or building society statement
Credit card statement
Pension letter or statement
Letter from a central, regional or local government department
Letter from an employer on headed paper
Letter from a school, college, or university on headed paper
TV licence
Letter from a bank
Letter from a medical service
Mortgage statement
Council tax bill or polling card
House, motor, travel or health insurance certificate or document
Letter from a solicitor
Formal tenancy agreement or letter from letting agent

Please note:

The UK driving licence paper counterpart is not an acceptable proof of address, even if it shows your current
address.

We will not accept any junk mail or envelopes.

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