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Identity Verifier DBS 3C Form
Identity Verifier DBS 3C Form
"
*
" indicates required fields
To be completed by the ID verifier
Name of Applicant
*
First
Middle
Last
Date used from
DD slash MM slash YYYY
Date used to
DD slash MM slash YYYY
Any Name Changes
Yes
No
Birth or other names used
First
Middle
Last
Date used from
DD slash MM slash YYYY
Date used to
DD slash MM slash YYYY
Birth or other names used
First
Middle
Last
Date used from
DD slash MM slash YYYY
Date used to
DD slash MM slash YYYY
Parish / Religious Order / Organisation:
*
Church (if applicable)
*
Volunteer Roles at the Parish
*
Add
Remove
Applicant's Email address:
*
Applicant's Phone Number
*
Applicant's Date of Birth
*
DD slash MM slash YYYY
Applicant's Current Address
*
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Document 1:
*
Documents provided for verification
Accepted file types: jpg, pdf, gif, png, Max. file size: 16 MB.
Document 2:
*
Documents provided for verification
Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.
Document 3:
*
Documents provided for verification
Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.
Document 4:
Documents provided for verification
Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.
Document 5:
Document provided for verification
Accepted file types: jpg, gif, png, pdf, Max. file size: 16 MB.
I confirm that the applicant has provided sufficient / explanation to prove ALL their name changes
*
* Please tick to confirm
At least one document provided contains a date of birth
*
At least one document provided contains a current address
*
At least one document provided confirms the applicant’s current full name
I confirm that I have seen the original identity documents above and I have permission from the applicant to attach the ID documents above or send them into the safeguarding office directly
*
ID Verifier's Full Name
*
First
Last
Name of your Parish (include town)/Religious Order or Organisation
*
Position
*
Signature
*
Date
*
DD slash MM slash YYYY
To be completed by the applicant: Signature
*
I consent to my data being processed and forwarded online by a secure third-party data processor for the purpose of my DBS application. I understand if I do not consent to an electronic result being issued to the registered body submitting my application that I must not proceed with my application. I understand that to withdraw my consent whilst my application is in progress I must contact the Archdiocese of Southwark Safeguarding Office or the DBS helpline 03000 200 190. My application will then be withdrawn. I agree that the safeguarding team can add the details of any birth or other names that I have supplied on this form, to my DBS application. Please Sign to confirm you agree to the above and enter your Name and Date below
To be completed by the applicant: Name
*
First
Last
To be completed by the applicant: Date
*
DD slash MM slash YYYY
