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Declaration

Please note that it is an offence under Section 33 of the Health and Safety at Work Act to provide false
information. Incomplete or inaccurate information could result in a delay in processing your application.
The information entered in this form may be stored electronically. The information may, where appropriate, be
shared with other relevant bodies such as other licensing authorities, local authorities, the police or the Health
and Safety Executive. You have the right to request a copy of any personal information and to have any
inaccuracies corrected.

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