Regulation 10(1)
1. Reason for application (whether an additional partner or replacement or job-sharing arrangement).
2. Particulars of each existing partner who will form part of proposed new partnership, including—
(a)name and cypher number;
(b)whether practising as—
(i)a full-time doctor;
(ii)a three-quarter-time doctor;
(iii)a half-time doctor; or
(iv)a job-sharing doctor;
(c)age;
(d)number of persons on list;
(e)proposed partnership shares, dates and exclusions (if any)—
(i)commencing;
(ii)first share change;
(iii)second share change; and
(iv)third share change;
(f)time spent on other health service appointments or health service administration, including—
(i)number of sessions;
(ii)type of appointment; and
(iii)average weekly hours; and
(g)time spent on regular non-health service appointments (eg Medical Referee, Police Surgeon, Occupational Medicine etc), including—
(i)type of appointment; and
(ii)average weekly hours.
3. Whether or not income from—
(a)other health service appointments; or
(b)non-health service appointments,
is pooled and shared according to partnership shares.
4. Declaration that each member of the proposed partnership shall discharge the duties and exercise the powers of a principal in connection with the practice of the partnership.
5. Declaration that none of the partners shall either jointly or separately be engaged in the buying or selling of the goodwill or any part of the goodwill of a medical practice, prohibited by Article 60 of and Schedule 10 to the Order, whether or not provided for in the Agreement mentioned in paragraph 6.
6. Undertaking to enter into an Agreement in writing embodying all the relevant conditions under which the partnership subsists and including provisions under which the partnership may be dissolved.
7. Undertaking to forward a copy of the Agreement mentioned in paragraph 6 to the Agency within a reasonable period of the commencement date of the Agreement.