| Please provide details of your current address and all previous addresses to cover a continuous 5 year period. | |
| Current Address Line 1 | 83 Station Road |
| Current Address Line 2 | Stanley |
| Current Address Line 3 | Ilkeston |
| Postcode | DE7 6FB |
| From | 10/12/2021 |
| 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 | 66 Scargill Road |
| Address Line 2 | West Hallam |
| Address Line 3 | Ilkeston |
| Postcode | DE7 6LF |
| From | 19/06/2020 |
| To | 10/12/2021 |
| Previous Address (2) | |
| Address Line 1 | 35 Mapleton Avenue |
| Address Line 2 | Chaddesden |
| Address Line 3 | Derby |
| Postcode | DE21 4PT |
| From | 01/06/2014 |
| To | 19/06/2020 |
| Previous Address (3) | |
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