Declaration of Own Work for Amendments

These details are used for registration with the awarding body for the course and will be printed on the certificate. These details must match your attached ID. A charge will be payable if the name needs to be changed at any point.

PLEASE NOTE: If you are using auto-fill to complete aspects of this declaration, please double check that all information provided is correct and information has not automatically populated into the wrong sections. Thank you!

Declaration of Own Work for Amendments

Please complete the entire form in full and as accurately as possible.

Full legal name as shown on ID (including any middle names)(Required)

Please note, this information is requested on behalf of the awarding organisation. Your declaration will be rejected if your name stated on this form does not match your ID and you could be subject to a charge.

First name Middle name(s) Surname

If you currently use, or have previously used, another name, please state it here

Date of birth(Required)

Address(Required)

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Gender(Required)

Ethnicity(Required)

Learning Difficulties or Disabilities(Required)

Yes

Please state your learning difficulties or disabilities here(Required)

Qualification title (This is the qualification you are completing with us)(Required)

Learner identification(Required)

PLEASE ATTACH COPY OF ONE PHOTOGRAPHIC I.D. (E.G. PASSPORT, DRIVING LICENCE, IDENTITY CARD)

Max. file size: 128 MB.

Learner signature(Required)