National Performers Lists Application Form Page 27
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32• disclosing information to NHS England in relation to my appraisal and
revalidation history which includes release of appraisal and revalidation
documentation.
I understand that my failure to comply with the requirements outlined in this declaration
that I have agreed to abide by may result in conditions being placed upon my name on
NHS England’s performers list)s) or may result in removal of my name from the list(s).
Name: (please print)
Signature:
Professional registration number:
Date: (DD/MM/YYYY)
NPL1 Application Form v2 final
Page 27 of 32
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