| Please provide details of your current address and all previous addresses to cover a continuous 5 year period. | |
| Current Address Line 1 | 5 Leyburn Close |
| Current Address Line 2 | Church Gresley |
| Current Address Line 3 | Swadlincote |
| Postcode | DE119PZ |
| From | 02/12/2016 |
| If you have been living at your current address for less than 5 years, please add more addresses below | |
| Previous Address (1) | |
| Address Line 1 | 61 Field Lane |
| Address Line 2 | |
| Address Line 3 | Burton-on-Trent |
| Postcode | DE130AT |
| From | 05/05/2010 |
| To | 01/12/2016 |
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| Previous Address (3) | |
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