| 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) | Miss |
| All Forenames | Leah Marie |
| Surname | Taylor |
| Name commonly known by | Leah |
| Surname at birth | Taylor |
| Date of birth | 04/03/1991 |
| National Insurance number | JK070369B |
| Home Tel | |
| Mobile Tel | 07714640239 |
| Other Telephone number | |
| Email Address | leahtaylor1991@me.com |
| Place of Birth | Liss |
| Nationality at Birth | British |
| Passport number (If National Insurance Number not Available) | |
| Candidate Individual Reference Number | |
| OR name of previous regulatory body | |
| AND previous reference number if applicable | |
| What is your intended method of engaging with customers (you can tick more than one if applicable) | |
| Online | |
| Telephone | True |
| Face to face | True |
| If applicable, please include below details of any other forenames and surnames used | |
| Previous Name(s) | Leah Vickers |
| Date from | 25/03/2022 |
| Date to | 01/09/2023 |
| Reason(s) for change | Divorce |
| Previous Name(s) | |
| Date from | |
| Date to | |
| Reason(s) for change | |
| Previous Name(s) | |
| Date from | |
| Date to | |
| Reason(s) for change | |