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 Date of Birth

Telephone Number 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
RG-001 140421 Application form / Vanters-1 / Ring & Go / Cousland

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