DepartmentDoctors
TitleDr
NameOKONKWO CHIDUMEBI MARYANN
Date of Birth30/04/1995
GenderFemale
Ni NumberTK490100A
Address History (Must date back 5 years)Flat 74 telecom house, Church Street, Wolverhampton, WV2 4AY
Church street
Wolverhampton, West Midlands WV2 4AY
United Kingdom
Map It
Date from (Address 1)24/10/2023
Date to (Address 1)31/01/2024
Address 2Flat 72 telecom house, Church Street, Wolverhampton, WV2 4AR
Church street
Wolverhampton, West Midlands WV2 4AR
United Kingdom
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Date from (Address 2)24/06/2023
Date to (Address 2)23/10/2023
Address 31 RANGER DRIVE
Wolverhampton, West Midlands WV1O 6BZ
United Kingdom
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Date from (Address 3)25/02/2023
Date to (Address 3)23/06/2023
Additional Addresses

ADDRESS 4: 64 DONNINGTON GROVE, WV10 6EE, WOLVERHAMPTON, WEST MIDLANDS, UNITED KINGDOM.
DATE FROM 21/01/2023 TO 24/02/2023

ADDRESS 5: 11 EGBEMA LANE, NEW HAVEN EXTENION, ENUGU, NIGERIA.
DATE FROM 7/01/2021 TO 20/01/2023

ADRESS 6: 11 DAN OGUGUA STREET, TRANS-EKULU, ENUGU, NIGERIA.
DATE FROM 13/01/2008 TO 6/01/2021

Place of BirthENUGU STATE
CountryNIGERIA
NationalityNIGERIAN
Nationality at birthNIGERIAN
Surname at birthANISIUBA
Used until13/02/2020
Previous Names (If applicable you must provide evidence of this – see below)ANISIUBA CHIDUMEBI MARYANN
Date from30/04/1995
Date to13/02/2020
Reason WhyMARRIAGE
Do you have any spent or unspent convictions?No
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
File
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Disclosure Check Consent

Consent I confirm
Signature
Date03/12/2023