Name: Date of Birth:
Licence No (if applicable):
D E C L A R A T I O N:
I am completing and paying £40 for my DBS, and aware that I am required to join the DBS update service scheme as
described below:
You can join the Update Service with your certificate number (located on the top right hand side of the form)
when you receive your DBS certificate. This must be done within 30 calendar days of the ‘date of issuewhich
is printed on the certifica
I also understand that the Licensing Service do not receive a copy of my DBS therefore I will need to produce my DBS
Certificate to the Licensing Service within 7 days of receipt.
I am aware that if I fail to produce this within 7 days I understand that there may be implications i.e. Suspension of
my Public/ Private hire Licence and I will have to complete and pay for another DBS.
I, as the individual to whom the Disclosure Barring Service (DBS) vetting record relates to, hereby declare that I provide
authority to Rochdale Borough Council Licensing Service to access and receive update information,
for the purposes of consideration of my licence application; and/or
on an annual basis during the lifetime of my licence; and/or
at any other times considered as deemed reasonably necessary to ascertain my fitness and propriety to hold
the relevant licence,
(within the meaning of 116A of the Police Act 1997) in relation to my criminal record for the purposes of asking an
exempted question within the meaning of Section 113A of the Police Act 1997; or in relation to my enhanced criminal
record for the purposes of asking an exempted question for a prescribed purpose within the meaning of Section 113B
of the Police Act 1997.
I understand that if my licence expires or I withdraw this authority by providing written notice to the Licensing Service,
Rochdale Borough Council will discontinue making any further status checks on my record via the DBS Update Service.
Signed: Date:
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