140421 RG001 Midlothian Council Ring & Go application formCD Application Form
1
Application for Ring & Go Cousland, Southfield and Langside areas Data Protection Act 1998 Under the terms of this Act, data provided will be held on a computer and used only for the Ring & Go Scheme Please use BLOCK LETTERS when writing information in this first box. Surname_______________________ Title Mr/Mrs/Miss/Other First Name(s) Permanent Address Postcode Telephone Number Date of Birth E-mail _____________________________ Declaration The information given on this form is correct. I agree to follow the conditions of the Ring & Go scheme. Signature Date For Office Use Only State proof of residency provided One Photograph provided Serial Number CD Date Issued Checked by RG-001 140421 Application form / Vanters-1 / Ring & Go / Cousland
Transcript of 140421 RG001 Midlothian Council Ring & Go application formCD Application Form
Application for
Ring & Go
Cousland, Southfield and Langside areas
Data Protection Act 1998 Under the terms of this Act, data provided will be held on a computer and used only for the Ring & Go Scheme
Please use BLOCK LETTERS when writing information in this first box.
Surname_______________________ Title Mr/Mrs/Miss/Other
First Name(s)
Permanent Address
Postcode Telephone Number
Date of Birth E-mail _____________________________
Declaration
The information given on this form is correct.
I agree to follow the conditions of the Ring & Go scheme.
Signature Date
For Office Use Only
State proof of residency provided
One Photograph provided
Serial Number CD
Date Issued Checked by RG-001 140421 Application form / Vanters-1 / Ring & Go / Cousland
