| Please provide details of your current address and all previous addresses to cover a continuous 5 year period. | |
| Current Address Line 1 | 14 Fair-Green Road |
| Current Address Line 2 | Baldwins Gate |
| Current Address Line 3 | Newcastle-under-Lyme |
| Postcode | ST5 5LS |
| From | 05/07/2019 |
| 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 | Upper Farm |
| Address Line 2 | Shut Lane Head |
| Address Line 3 | Newcastle-under-Lyme |
| Postcode | ST5 4DS |
| From | 15/09/2015 |
| To | 04/07/2019 |
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| Previous Address (3) | |
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