| Please provide details of your current address and all previous addresses to cover a continuous 5 year period. | |
| Current Address Line 1 | 42 Sackville Road |
| Current Address Line 2 | St Helens |
| Current Address Line 3 | Merseyside |
| Postcode | WA10 6JB |
| From | 12/08/2012 |
| 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 | |
| Address Line 2 | |
| Address Line 3 | |
| Postcode | |
| From | |
| To | |
| Previous Address (2) | |
| Address Line 1 | |
| Address Line 2 | |
| Address Line 3 | |
| Postcode | |
| From | |
| To | |
| Previous Address (3) | |
| Address Line 1 | |
| Address Line 2 | |
| Address Line 3 | |
| Postcode | |
| From | |
| To |