DepartmentDoctors
TitleDr
NameEsosa Ikponmwosa Osamwonyi
Date of Birth30/05/1990
GenderMale
Ni NumberSX583560A
Address History (Must date back 5 years)14 John Dixon Lane
Darlington
Darlington, Durham DL1 1HG
United Kingdom
Map It
Date from (Address 1)01/11/2021
Date to (Address 1)15/11/2023
Address 211 Deanery Court
Darlington
Durham, Durham DL3 6AQ
United Kingdom
Map It
Date from (Address 2)01/08/2021
Date to (Address 2)31/10/2021
Address 3Flat 86, The Panorama
ashford
Kent, Kent TN24 8DF
United Kingdom
Map It
Date from (Address 3)01/04/2020
Date to (Address 3)31/07/2021
Additional Addresses

1)20 Broomfield Residence,
Willesborough,
Ashford,
2
Kent.
TN24 0LY.
10/12/2019 - 31/3/2021
2)7 Dawson Road
Benin city,
Edo state
Nigeria.
10 years.

Place of BirthLagos
CountryNigeria
NationalityNigerian
Nationality at birthNigerian
Surname at birthOsamwonyi
Used until15/11/2023
Previous Names (If applicable you must provide evidence of this – see below)NA NA NA
Reason WhyNA
Do you have any spent or unspent convictions?Yes
If yes please provide a statement below:

Drink driving conviction 1/8/22

HTML BlockWe need 3 forms of ID before we can apply for your CRB. We must have 1 from Group 1 and 2 from group 2 - Please note we MUST have addressed ID! (All utility bills and Statements must be addressed to your current address)

Group 1

Valid Passport (any nationality)
UK Driving License (photo card only valid if paper part present)


Group 2

UK P45/P60 Statement (issued within last the last 12 months)
Bank or Building Society Statement (issued within the last 3 months)
Credit Card Statement (issued within the last 3 months)
UK Mortgage Statement from a recognised lender
Local council rent card or tenancy agreement (issued within the last 3 months)
Utility Bill - electric, gas, water, telephone - must be a landline bill (issued within the last 3 months), we can accept more than one utility bill as long as they are from different suppliers)
Council Tax Statement (issued within the last 12 months)
Benefit Statement, book or card; or original letter from the Department of Work and Pensions (DWP) confirming the rights to benefit – i.e child allowance, pension (issued within the last 12 months)
Confirmation from an electoral register search that a person of that name lives at claimed address (issued within the last 12 months)

Name Changes

If you have declared that you have had name changes you must provide us with evidence of this:

Marriage certificate or Civil partnership certificate Birth certificate
Adoption certificate
Divorce, dissolution or annulment papers
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Disclosure Check Consent

Consent I confirm
Signature
Date15/11/2023