| The details which you provide within this application form are the basis of your disclosure. Credit Checks & Criminal Records Bureau Checks will be made and references taken, therefore the omission of any relevant details may result in your application being delayed. | |
| Title (If other, please state) | Ms |
| All Forenames | Ruth Laura |
| Surname | Atkinson |
| Surname at birth | Atkinson |
| Date of birth | 05/05/1974 |
| National Insurance number | JA571135D |
| Home Tel | 07368621048 |
| Mobile Tel | 07368621048 |
| Other Telephone number | |
| Email Address (Your email address within the Firm - please do not use a personal email address) | ruthlatkinson@outlook.com |
| If applicable, please include below details of any other forenames and surnames used | |
| Previous Name(s) | Ruth Nowak |
| Date from | 28/04/2007 |
| Date to | 21/01/2021 |
| Reason(s) for change | Deed poll |
| Previous Name(s) | Ruth Elliott |
| Date from | 08/08/1999 |
| Date to | 28/04/2007 |
| Reason(s) for change | Marriage |
| Previous Name(s) | Ruth Atkinson |
| Date from | 05/05/1974 |
| Date to | 08/08/1999 |
| Reason(s) for change | name from birth to marriage |