1. The applicant’s full name, date of birth, current address, telephone number and electronic mail address (if any).
2. Details of the applicant’s professional or technical qualifications, and experience of managing a private dental practice, so far as such qualifications and experience are relevant to providing services for persons for whom services are to be provided at the private dental practice.
3. Details of the applicant’s professional training relevant to carrying on or managing a private dental practice.
4. Details of the applicant’s employment history, including the name and address of their present employer and of any previous employers.
5. Details of any business the applicant carries on or manages or has carried on or managed.
6.—(1) The name and addresses of two referees—
(a)who are not relatives of the applicant;
(b)each of whom is able to provide a reference as to the applicant’s competence to manage private dental practice of the same description as the private dental practice; and
(c)one of whom has employed the applicant for a period of at least 3 months.
(2) The requirement for the name and address of a referee who has employed the applicant for a period of at least 3 months must not apply where it is impracticable to obtain a reference from a person who fulfils that requirement.
7. The name, address, telephone number, facsimile number (if any), and electronic mail address (if any) of the private dental practice.
8. If the applicant is a dentist or dental care professional—
(a)the responsible person’s professional registration number; and
(b)details of any conditions imposed on the responsible person’s professional registration or inclusion on a dental performers list.