The National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003

2.  An application shall contain the following declarations:–

(a) that the applicant’s name is included in the Medical Register;

(b) whether the applicant has been convicted of a criminal offence, bound over or cautioned in the United Kingdom or elsewhere, and if so, as to approximate dates of what the action or proceedings were, or are to be, brought, the nature of that action or proceedings and any outcome;

(c) whether the applicant has been or is currently, subject to any action by any professional body, or by any licensing or regulatory body, in the United Kingdom or elsewhere, and if so, as to approximate dates of what the action or proceedings were, or are to be, brought, the nature of that action or proceedings and any outcome;

(d) whether the applicant has been, or is the subject of proceedings which might result in the applicant being removed or suspended from or refused admission to a medical list (or any equivalent or similar list in England, Wales or Northern Ireland);

(e) that the applicant consents to a request being made to any employer or former employer and any regulatory or other body, wherever they may be, for information relating to any of the matters referred to in this paragraph or paragraph (1);

(f) that in assisting in the provision of contraceptive services the applicant shall be guided by modern authoritative medical opinion and contraceptive practice; and

(g) that the applicant will comply with the National Health Service (General Medical Services Supplementary Lists) (Scotland) Regulations 2003.