National Performers Lists Application Form Page 24
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32Yes
No
(g) Are you currently the subject of any investigation by the NHS
Business Services Authority in relation to fraud
(h) Are you currently the subject of any investigation by the holder of
any list which might lead to the body corporates removal from that
list
(i) Have you ever been removed or are you currently suspended from,
or have you been refused inclusion in or included subject to
conditions in, any list
(j) Are you currently, or have you ever been, subject to a national
disqualification
Name: (please print)
Signature:
Professional registration number:
Date: (DD/MM/YYYY)
NPL1 Application Form v2 final
Page 24 of 32
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