Nancye Atherton

• 1. their birth was never registered; 2. they reside in a remote community; 3. they have no bills in their own name; 4. they have no personal bank account; and/or 5. their documents were lost due to fire, theft or natural disaster and they have been unable to obtain replacements. (Note: If the applicant does not meet any of these listed criteria, then National Crime Check should be contacted by email at support@nationalcrimecheck.com.au prior to proceeding with this application.) Why have your circumstances specified above prevented you from being able to provide the minimum identity documents? I don’t have a birth certificate and my passport is expired by more than 2 years I, the person completing this form, declare that all information in this form is accurate and correct to the best of my understanding.
• Name of applicant (please print) OFFICE USE ONLY The Legal Entity Customer declares that: it has verified that the reason provided by the applicant with regards to why the applicant is unable to provide the minimum proof of identity documents is legitimate; the applicant has satisfied (tick each box that applies): Special Provision 1 Special Provision 2 Special Provision 3 for the purposes of submitting a request for a police check in circumstances where the minimum proof of identity documents are unable to be provided; and based on the documentation and evidence provided, the Legal Entity Customer is satisfied as to the applicant’s identity, and the linkage between the applicant and the claimed identity. The Applicant was denied the special provisions The Legal Entity Customer determined that the Special Provisions apply based on the following reasons (record any consideration, verification and/or linkage exercises undertaken to support the Legal Entity Customer’s decision-making process): Staff member DATE: Name of staff member (please print) Signature Notes: The Special Provisions are not to be applied in circumstances where mere inconvenience forms the basis for the applicant’s inability to provide the minimum identity documents, or where genuine financial hardship has not been established and corroborated. The Legal Entity Customer should only sign this declaration where the Legal Entity Customer has determined that the applicant has satisfied the Special Provisions. If the Legal Entity Customer determines that the Special Provisions are not satisfied, then the Legal Entity Customer should keep a record of the considerations and reasons for denying the application for Special Provisions. Page 1 of 3

I am a home style cooker, plain meals that my husband and friends enjoy. Christmas cakes and puddings. soups, sausage rolls and pies.