2. An application shall contain the following declarations as to whether or not the applicant –
(a)is a medical practitioner included in both registers;
(b)if the applicant is a GP Registrar, and is not a fully registered medical practitioner included in the register of medical practitioners, that the applicant is registered in that register with limited registration, with details of the limits of that registration, as defined in the direction by virtue of which the applicant is registered;
(c)has been convicted of a criminal offence in the United Kingdom;
(d)has been convicted elsewhere of an offence which would constitute a criminal offence if committed in Northern Ireland;
(e)is currently the subject of any proceedings which might lead to a conviction specified in sub-paragraph (c) or (d);
(f)has, in summary proceedings in Scotland in respect of an offence, been the subject of an order discharging the applicant absolutely (without proceeding to conviction);
(g)has accepted and agreed to pay a penalty under section 109A of the Social Security Administration (Northern Ireland) Act 1992(1), a penalty under section 115A of the Social Security Administration Act 1992(2) or a procurator fiscal fine under section 302 of the Criminal Procedure (Scotland) Act 1995(3);
(h)has accepted a police caution in the United Kingdom;
(i)has been bound over following a criminal conviction in the United Kingdom;
(j)has been subject to any investigation into the applicant’s professional conduct by any licensing, regulatory or other body where the outcome was adverse;
(k)is currently subject to any investigation into the applicant’s professional conduct by any licensing, regulatory or other body;
(l)is the subject of any investigation or proceedings by another Board or equivalent body which might result in the applicant being disqualified, conditionally disqualified, removed or suspended from a list, or equivalent list;
(mis, or has been, where the outcome was adverse, the subject of any investigation into the applicant’s professional conduct in respect of any previous or current employment;
(n)is, or has in the preceding 6 months been, or was at the time of the events that gave rise to conviction, proceedings or investigation, a director or one of the body of persons with control of a body corporate which –
(i)has been convicted of a criminal offence in the United Kingdom;
(ii)has been convicted elsewhere of an offence which would constitute a criminal offence if committed in Northern Ireland;
(iii)is currently the subject of any proceedings which might lead to such a conviction; or
(iv)has been subject to any investigation into its provision of professional services by any licensing, regulatory or other body;
(o)that the applicant consents to a request being made by the Board to any employer or former employer, licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, into the applicant or a body corporate referred to in this paragraph and, for the purposes of this sub-paragraph, “employer” includes any partnership of which the applicant is or was a member.
1992 c. 8. Section 109A was inserted by Article 14 of S.I. 1997/1182 (N.I. 11)
1992 c. 5. Section 115A was inserted by section 15 of the Social Security Administration (Fraud) Act 1997 (c. 47)