Disclosures Online Form

Disclosure form

STEP 1: Your group needs to download and complete a PVG Contract with LAYC

STEP 2: The individual person should complete the application filling in the Disclosures Online Form below using BLOCK CAPITAL letters (we suggest pressing the CAPS LOCK key on your keyboard).

STEP 3: This information is entered onto a PVG Scheme Application form by LAYC . The individual perason needs to contact LAYC to arrange ...

STEP 4:T o come in to the LAYC Offices to check and signthe application.They will also have to produce at least three forms of identity (one of them should be photographic and there should be two recent proofs of address, such as a utility bill and a bank statement).

If you have any enquiries relating to the information requested below please do not hesitate to contact us at LAYC on 0131 667 1828 or email enquiries@layc.org.uk

All fields should be filled in unless indicated otherwise.

PVG Membership

I am already a PVG member
Yes No 

I am applying for:

Scheme Record  (You will receive a copy of this as will LAYC on behalf of the organisation employing you.)
Scheme Update  (You will receive a copy of this as will LAYC on behalf of the organisation employing you.)

Scheme Membership Statement  (When you are joining the scheme in anticipation of doing regulated work in the future.)

Details of Group

Group name

Club/Group/Organisation is a voluntary sector charitable body
Yes No 

Position applied for

Position is paid
Yes No 

Position is 'regulated work'
Yes No 

Name(s)

Title

Dr Mr Mrs Miss Ms 

Present surname

Present forenames (please include all middle names)

Name at birth (only complete if different to present names)

Birth surname

Birth forenames (please include all middle names)

If you are known by, or have previously been known by, any other name then enter the details here.

Other surname

Other forenames (please include all middle names)

Mother's family/maiden name

Birth details

Date of birth DD/MM/YY

Gender
Male Female 

Town of birth

Contact information

Telephone number (including STD code)

Email address

Additional Information

Do you have a UK National Insurance Number

Yes No 

If yes, what is it?

Do you have a UK Passport

Yes No 

If yes, what number is it?

And what is the country of issue?

Do you have a Driving License

Yes No 

If yes, what number is it?

And what is the country of issue?

Are you now or have you ever been
A member of the PVG scheme Yes No 
Registered with the ISA Yes No 

Current home address

Address (number, street)

Post town

County/Region

Country (leave blank if UK)

Post code

Resident from (DD/MM/YY)

Home address history

If you have not lived at your current home address for FIVE years then please provide your previous addresses covering this period, with the most recent first.

Address (number, street)

Post town

County/Region

Country (leave blank if UK)

Post code

Resident from (YYYY)

Address (number, street)

Post town

County/Region

Country (leave blank if UK)

Post code

Resident from (YYYY)

Address (number, street)

Post town

County/Region

Country (leave blank if UK)

Post code

Resident from (YYYY)

Address (number, street)

Post town

County/Region

Country (leave blank if UK)

Post code

Resident from (YYYY)

SSSC GTC

If you are registered with the SSSC or GTC for Scotland you can have a duplicate copy sent to them too.

SSSC:
Yes No 
SSSC registration number

GTC:
Yes No 
GTC registration number

Indentification

I am aware that I am required to provide a minimum of three forms of identification, one of them being photographic. These forms of ID should confirm my name and date of birth and my recent home address (within the past three months). The forms of ID I will be presenting will be:

Birth Certificate Passport Driving License with Photograph Driving License without Photograph National ID card National Entitlement card Other  (If other please specify)