Clare's Law - Domestic Violence Disclosure Scheme application form : Page 1 of 6

Clare's Law - Domestic Violence Disclosure Scheme application form

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Your details

Title

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First name

Last name

Home address

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Postcode Search

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Your address

Building and street line 1 of 2

Building and street line 2 of 2

Town or city

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Postcode

Email Address

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Alternative contact methods

Please provide at least one alternative contact method

Home Telephone

Work Telephone

Mobile

Home Telephone

Please enter your Home Phone Number

Work Telephone

Please enter your Work Phone Number

Mobile Telephone

Please enter your Mobile Phone Number

What is the reason you are making this request?

Does the person who you think may be at risk know you are making this application?

Please choose one of the options

Yes as I am the person who may be at risk

Yes I have made them aware

Yes they have asked me to make the application on their behalf

No I have not made them aware

What is your relationship with the person you think may be at risk?

If you are making this application for your own safety select the first option. If you are making the application with concern from someone else please choose one of the options to describe your relationship with them.

I am the person who may be at risk

They are a friend

They are my sibling

They are my parent

They are my ex-partner

They are a colleague

They are my child

Other

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