1.  Name, date and place of birth.

2.  Address.

3.  Nationality and race.

4.  Whether the proposed adopter has his home in Great Britain and, if not, the address at which he has his home, if different from 2 above.

5.  Whether the proposed adopter is domiciled or habitually resident in the UK (ie England, Wales, Scotland, Northern Ireland) the Channel Islands or the Isle of Man, and, if not, the country in which he is domiciled or habitually resident. If habitually resident, for how long.

6.  If the proposed adopter intends to apply for an order under section 49 of the Act, whether he intends to adopt the child in law or in fact in the country in which he is domiciled.

7.  If there are two proposed adopters–

(a)the date and place of the proposed adopters' marriage;

(b)whether either proposed adopter has previously been married;

(c)if so, whether that marriage was dissolved or annulled;

(d)the grounds for the divorce or annulment;

(e)whether there are any financial commitments in respect of a former spouse and/or children of a previous marriage.

8.  If there is only one proposed adopter, whether that person is married; if so why the spouse does not join in the application, and in particular whether the spouse:–

(a)cannot be found;

(b)is separated and living apart, and the separation is likely to be permanent; or

(c)by reason of physical or mental ill-health is incapable of joining in the application.

9.  Details of other members of the prospective adopter’s household (including any children of the prospective adopter even if they are not resident in the household).

10.  Details of the prospective adopter’s parents and any of the prospective adopter’s brothers or sisters, with their ages or ages at death.

11.  Attitudes to adoption of such other members of the prospective adopter’s household and of such of the other members of the prospective adopter’s family as the adoption agency considers appropriate.

12.  Personality.

13.  Previous experience of caring for children and assessment of ability in this respect together, where appropriate, with assessment of ability in bringing up own children.

14.  Whether the prospective adopter or any other adult member of the household has previously:–

(a)notified a local authority of his intention to adopt a child;

(b)applied to an adoption agency with a view to adopting a child;

(c)had in his care and possession a foster child within the meaning of section 1 of the Foster Children (Scotland) Act 1984(1) who has been removed under section 12 of that Act;

(d)been disqualified or prohibited from keeping a foster child under section 7 or as the case may be section 10 of the Foster Children (Scotland) Act 1984 or disqualified or prohibited under section 68 or as the case may be section 69 of the Children Act 1989(2) from fostering a child privately;

(e)had in his care and possession a protected child who has been removed under section 34 of the Adoption Act 1976(3);

(f)been convicted of an offence mentioned in Schedule 1 to the Criminal Procedure (Scotland) Act 1995(4) or of an offence under Schedule 1 to the Children and Young Persons Act 1933(5);

(g)had parental responsibilities and rights in respect of one or more of his own children transferred to a local authority under section 86 of the 1995 Act or had one or more of such children made subject to care orders under section 31 of the Children Act 1989(6);

(h)been refused registration as a child minder or worker in a nursery under the Children Act 1989,

and details of any such occurrence.

15.  Assessment of ability to bring up an adopted child throughout his childhood.

16.  Religious persuasion including the degree of his religious observance.

17.  His ability to have regard to a child’s religious persuasion, racial origin and cultural and linguistic background.

18.  Educational attainments.

19.  Past and present occupations and interests.

20.  Details of financial circumstances and comments on the living standards of the household.

21.  Opinion of adoption agency as to whether any adoption allowance should be considered.

22.  Reasons for wishing to adopt a child and extent of understanding of the nature and effect of adoption.

23.  Names and address of two referees who are not close relatives who will give personal references on the prospective adopter.

24.  Name and address of the prospective adopter’s registered medical practitioner.

25.  A comprehensive medical report on the prospective adopter signed by a fully registered medical practitioner, including such details as the medical adviser to the adoption agency considers necessary in the circumstances of each prospective adopter.

26.  Any other relevant information which the adoption agency considers may assist the panel.