Email address Contact address Postcode Country Part 8: Declaration to be signed by the person making the referral – I wish the NCTL to investigate the above allegation of serious misconduct potentially leading to the imposition of a prohibition order. I confirm that the contents of this form are true to the best of my knowledge and belief. I understand that a copy of this form and any enclosures may be disclosed to the teacher and any employer in accordance with the NCTL’s procedures and give my consent to this. I confirm that I have obtained any necessary permission from third parties for the documents to be so disclosed. I understand that I may be required to attend a hearing of a professional conduct panel to give evidence should this allegation reach that stage. Signature: Date: Name (in BLOCK CAPITALS): Job title / position (if relevant): Organisation (if relevant): Relationship to the individual you are referring: J. Returning the form Please check that you have answered all the questions you can and you have signed or typed your name in the Declaration above. This form should be returned, together with all supporting documentary evidence, to the address below by post or via email. NCTL Investigations Team Teacher Regulation NCTL 53-55 Road Earlsdon Park
Email address Contact address Postcode Country Part 8: Declaration – to be signed by the person making the referral I wish the NCTL to investigate the above allegation of serious misconduct potentially leading to the imposition of a prohibition order. I confirm that the contents of this form are true to the best of my knowledge and belief. I understand that a copy of this form and any enclosures may be disclosed to the teacher and any employer in accordance with the NCTL’s procedures and give my consent to this. I confirm that I have obtained any necessary permission from third parties for the documents to be so disclosed. I understand that I may be required to attend a hearing of a professional conduct panel to give evidence should this allegation reach that stage. Signature: Date: Name (in BLOCK CAPITALS): Job title / position (if relevant): Organisation (if relevant): Relationship to the individual you are referring: J. Returning the form Please check that you have answered all the questions you can and you have signed or typed your name in the Declaration above. This form should be returned, together with all supporting documentary evidence, to the address below by post or via email. NCTL Investigations Team Teacher Regulation NCTL 53-55 Road Earlsdon Park