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    Statutory Declaration Form

    Uploaded by

    mackcaslangan08
    The statutory declaration outlines the requirements and obligations for applicants seeking registration with a professional registration board. The applicant declares that they meet eligibility criteria, such as being mentally and physically capable of fulfilling the job duties. They also agree to abide by the profession's code of ethics, pay registration fees, and disclose any criminal convictions or changes in circumstances that could impact their eligibility. The applicant signs the declaration in the presence of a witness such as a solicitor or notary public to attest that the information provided is true.

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    Statutory Declaration Form

    Uploaded by

    mackcaslangan08
    48 views3 pages
    The statutory declaration outlines the requirements and obligations for applicants seeking registration with a professional registration board. The applicant declares that they meet eligibility criteria, such as being mentally and physically capable of fulfilling the job duties. They also agree to abide by the profession's code of ethics, pay registration fees, and disclose any criminal convictions or changes in circumstances that could impact their eligibility. The applicant signs the declaration in the presence of a witness such as a solicitor or notary public to attest that the information provided is true.

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    The statutory declaration outlines the requirements and obligations for applicants seeking registration with a professional registration board. The applicant declares that they meet eligibility criteria, such as being mentally and physically capable of fulfilling the job duties. They also agree to abide by the profession's code of ethics, pay registration fees, and disclose any criminal convictions or changes in circumstances that could impact their eligibility. The applicant signs the declaration in the presence of a witness such as a solicitor or notary public to attest that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    48 views3 pages

    Statutory Declaration Form

    Uploaded by

    mackcaslangan08
    The statutory declaration outlines the requirements and obligations for applicants seeking registration with a professional registration board. The applicant declares that they meet eligibility criteria, such as being mentally and physically capable of fulfilling the job duties. They also agree to abide by the profession's code of ethics, pay registration fees, and disclose any criminal convictions or changes in circumstances that could impact their eligibility. The applicant signs the declaration in the presence of a witness such as a solicitor or notary public to attest that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Statutory Declaration

    In accordance with prevailing legislation, applicants for registration must make this
    statutory declaration. ‘Registration Board’ refers to the Registration board for your
    profession _______________________ (insert name of your profession).

    I,……………….………………….. of ……………….……….……………………….………
    (Name) (Home address)

    Declare as follows:
    1. I am not aware of any reason on grounds of physical or mental health why I might be
    unable to discharge the responsibilities of the profession for which I am applying for
    registration.
    2. I have read, understood and will comply with the Code of Professional Conduct and Ethics
    for my profession.
    3. I understand that I would be guilty of an offence if I make or cause to be made any false
    declaration or misrepresentation to obtain registration.
    4. I agree to pay the correct fees for my registration.
    5. I acknowledge that it is up to the Registration Board to decide if I meet the requirements
    for registration as set out in the Health and Social Care Professionals Act 2005 (as
    amended).
    6. I have not at any time been refused registration or a licence by a body in the
    Republic of Ireland, or in any other jurisdiction.
    7. I have not at any time had conditions imposed on my registration or license, or had my
    registration or license suspended, withdrawn or removed by a body in the Republic of
    Ireland, or in any other jurisdiction.
    8. I have never been convicted in the Republic of Ireland of an offence triable on
    indictment, (other than a spent conviction within the meaning of section 5 of the Criminal
    Justice (Spent Convictions and Certain Disclosures) Act 2016).1
    9. I have never been convicted in another jurisdiction of an offence which, if carried out in
    the Republic of Ireland, would constitute an offence triable on indictment.
    10. I understand that the Registration Board has the right to verify or to ask me to verify any
    information contained in my application and to ask me to supply additional information in
    relation to my application. The Registration Board may ask me to supply this additional
    information by means of a statutory declaration.

    1
    If you are unsure whether you have been convicted of an offence which is triable on indictment in Ireland (or
    would be if the offence had been committed here), you should take your own legal advice. If you do not disclose
    a conviction which you should have disclosed, you may be prosecuted.

    You do not have to disclose convictions which are spent, within the meaning of section 5 of the Criminal Justice
    (Spent Convictions and Certain Disclosures Act 2016). You should take legal advice in relation to when convictions
    are spent. If you do not disclose a conviction which you should have disclosed, you may be prosecuted.

    Health and Social Care Professionals Council (CORU) Page 1 of 3


    11. I agree to Garda vetting.
    12. I agree to provide a Police Clearance certificate from the Police Authority in each country
    where I have lived abroad for one year and one day or longer since the age of 18.
    13. I consent to the Registration Board making such enquiries as it considers appropriate on
    receipt of Garda Vetting or Police Clearance.
    14. I understand that canvassing of Council or Registration Board members, educational
    bodies, employers or anyone else in relation to my application is forbidden. I
    acknowledge that canvassing will not help my application and that the Registration Board
    will be told of any attempts at canvassing.
    15. I agree to tell the Registration Board if my circumstances change during the course of
    my registration, especially if the change would have caused me to answer any of these
    questions differently. In particular, I agree to tell the Registration Board as soon as
    practicable about:
    a. any mistakes in the Register that I know about and that relate to my
    registration;
    b. any change in my name or address or contact details or any change of
    employer.
    c. any granting to me by a body (other than the Registration Board) inside or
    outside the State, of a licence, certificate or registration relating to the practice
    of any profession;
    d. any change in the status of such licence, certificate or registration (including
    any conditions attached to it);
    e. anything likely to affect my right to such licence, certificate or registration
    (including any material matter); and
    f. anything likely to affect my right to be registered under the Health and Social
    Care Professionals Act 2005 (including any material matter).
    16. I understand that if a complaint is made about me I may become the subject of the
    complaints, inquiries and discipline provisions of the Health and Social Care
    Professionals Act, 2005.
    17. I know of no reason why the Registration Board should not grant me registration under
    the Health and Social Care Professionals Act 2005.
    18. I have signed this form in my handwriting. The information in this form and in the
    support documents that I have provided is true and accurate to the best of my knowledge
    and belief.

    I make this solemn declaration conscientiously and believe all the statements in it are true.
    Declared before me by:
    ……………………………………………………
    (insert name of the applicant swearing the declaration
    in capitals)
    who is personally known to me or who was identified to
    me by:

    Health and Social Care Professionals Council (CORU) Page 2 of 3


    ……………………………………………………
    Or
    Whose identity has been established to me before the
    taking of this declaration by the production to me of
    passport number…………………………… issued on
    …………………….…………. …..by the authorities of
    …………………..…………….., which is an authority
    recognised by the Irish Government.
    Or
    National identity card no. ……………………..issued on
    …………………………….….. by the authorities of
    ………………………………..…….. [which is an EU
    Member State, the Swiss Confederation or a
    Contracting Party of the EEA Agreement]

    At ……………………..………………….……………….
    …………………………………………………………….
    in the county or city of ………………………………….
    This ……… day of …..…………. in the year…………

    ……………………………… ….……………………………………………….
    Signature of applicant Signature and seal of a Practising Solicitor /
    Notary Public / Commissioner for Oaths /
    Peace Commissioner

    (If you do not possess an official seal or stamp, then


    you must provide full name and address in block
    capitals)

    Health and Social Care Professionals Council (CORU) Page 3 of 3

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