F7except where the applicant is an optician that is a body corporate, the applicant's full name, sex, date of birth and private address and telephone number;

F8except where the applicant is an optician that is a body corporate, a full description of the applicant's qualifications including the institution which awarded them;

the applicant's professional registration number and date of first registration;

whether the applicant is an ophthalmic medical practitioner, a registered optometrist or a body corporate;

address of proposed F1practice premises and, in the case of any mobile practice, the address to which correspondence may be sent and the addresses of any day centres and residential centres to be visited more than once;

whether the F2practice premises may be reached without use of stairs;

whether the F3practice premises have wheelchair access;

proposed days and hours of attendance at these F4practice premises and, in the case of any mobile practice, the month in which visits are intended to take place and the planned interval between such visits;

the name of each ophthalmic medical practitioner or optician who is regularly engaged as a deputy, director or employee in the provision of general ophthalmic services;

F9except where the applicant is an optician that is a body corporate, chronological details of the applicant's professional experience (including the starting and finishing dates of each appointment together with explanation of any gaps between appointments) with any additional supporting particulars, and an explanation of why the applicant was dismissed from any post;

details of any list or equivalent list from which the applicant F10(and, where the applicant is an optician that is a body corporate, all directors of the body corporate) has ever been disqualified, conditionally disqualified, removed, suspended, contingently removed or suspended or to which admission was refused or conditionally granted together with reasons for such disqualification, conditional disqualification, removal, suspension or refusal;

F11except where the applicant is an optician that is a body corporate, name and addresses of two referees who are willing to provide clinical references relating to two recent posts as an ophthalmic medical practitioner or optometrist each of which lasted at least 3 months without a significant break and which may include a current post, or, where this is not possible a full explanation and name and address of an alternative referee or referees;

F12except where the applicant is an optician that is a body corporate, if the applicant is a national of an EEA state, evidence that the applicant has a knowledge of English which, in the interests of the applicant and of patients who may receive general ophthalmic services from the applicant, is necessary for providing general ophthalmic services;

if the applicant is the director or one of the persons with control of a corporate body, F13or, if the applicant is an optician that is a body corporate, the body corporate’s name, registered office and registered number, telephone number, e-mail address and a list of the full names, dates of birth, private addresses and (if they have one) the national insurance numbers, of all the directors and the secretary;

if the applicant F14(and, where the applicant is an optician that is a body corporate, all directors of the body corporate) is, or has been where the outcome was adverse, the subject of any investigation F5... in relation to fraud;

whether the applicant is subject to a disqualification order under the Company Directors Disqualification Act 1986 M2, the Companies (Northern Ireland) Order 1986 M3 or to an order made under section 429(2)(b) of the Insolvency Act 1986 M4 (failure to pay under county court administration order).

has been convicted of a criminal offence in the British Islands or has been convicted elsewhere of an offence which would constitute a criminal offence if committed in the British Islands;

is currently the subject of any proceedings anywhere in the world which might lead to a conviction specified in sub-paragraph (a);

has in summary proceedings in respect of an offence, been the subject of an order discharging the applicant absolutely (without proceeding to conviction);

has accepted and agreed to pay either a procurator fiscal fine under section 302 of the Criminal Procedure (Scotland) Act 1995 M5 or a penalty under section 115A of the Social Security Administration Act 1992 M6;

has accepted a police caution in the British Islands;

has been bound over following a criminal conviction in the British Islands;

has been subject to any investigation into the applicant's professional conduct by any licensing, regulatory or other body anywhere in the world where the outcome was adverse;

is currently subject to any investigation into the applicant's professional conduct by any licensing, regulatory or other body anywhere in the world;

is the subject of any investigation or proceedings by another Health Board or equivalent body which might result in the applicant being disqualified, conditionally disqualified, refused entry, granted entry subject to conditions, removed, contingently removed or suspended from a list, or equivalent list;

is, or has been, where the outcome was adverse, the subject of any investigation into the applicant's professional conduct in respect of any previous or current employment;

has had sequestration of the applicant's estate awarded or been adjudged bankrupt;

has been made the subject of a bankruptcy restrictions order or an interim bankruptcy restrictions order under Schedule 4A to the Insolvency Act 1986;

has made a composition or arrangement with, or granted a trust deed for, the applicant's creditors;

is subject to a disqualification order under the Company Directors Disqualification Act 1986, the Companies (Northern Ireland) Order 1986 or to an order made under section 429(2)(b) of the Insolvency Act 1986 (failure to pay under county court administration order).

an enhanced criminal record certificate in relation to the applicant or, where the applicant is an optician that is a body corporate, in relation to each director, dated not earlier than 28 days before the date of the application; or

an application for such certificate required in terms of sub-paragraph (a) duly completed and signed by the applicant or, where the applicant is an optician that is a body corporate, completed and signed by each director of that body corporate; and

except in the case of a body corporate carrying on business as an optometrist, a certificate F6, dated not earlier than 2 years before the date of the application where the applicant has not worked in Scotland within that 2 year period, from a provider of training approved by NHS Education for Scotland that the applicant has satisfactorily completed a course of training in the use of slit lamp biomicroscopy, condensing lens biomicroscopy, applanation tonometry and threshold visual fields.

the applicant will participate in appropriate and relevant NHS audit procedures;

that applicant will be bound by the terms of service;

that the applicant F16and, where the applicant is an optician that is a body corporate, all directors of the body corporate, consents to a request being made by the Board to the Agency, any employer or former employer of the applicant F17or of any director as the case may be, licensing, regulatory or other body in the United Kingdom or elsewhere, for information relating to a current investigation, or an investigation where the outcome was adverse, into the applicant or a body corporate referred to in this paragraph and, for the purposes of this sub paragraph, “employer” includes any partnership of which the applicant is or was a member;

that the applicant consents to disclosure of information in terms of regulation 14; and

that the fixed or mobile premises from which the applicant will provide general ophthalmic services contains the required equipment.