Individual providers

Part 1: The forms you need to fill in

There are 5 forms you must complete:

1. Application of registration

• Form R2-I individual providers application (Word, 587 KB, opens in a new window)

2. Information specific to your service

• Appendix A - care homes (Word, 329 KB, opens in a new window)
• Appendix A - Domiciliary care agencies Word, 307 KB, opens in a new window)
• Appendix A - Nurses' agencies (Word, 308 KB, opens in a new window)
• Appendix A - Adult placement schemes (Word, 312 KB, opens in a new window)

3. Medical reference form

• Appendix B medical reference form (Word, 317 KB, opens in a new window)

4. Financial reference form

• Appendix C financial reference form (Word, 317 KB, opens in a new window)

5. Fee for registration

Please make sure you send us the right fee with your form.

The list of registration fees are can be found on Appendix D.

• Appendix D fees form (Word, 318 KB, opens in a new window)

Optional: Diversity monitoring form

Please fill in this form so we can monitor the diversity of people who apply for registration. We will use the information for monitoring purposes only.

• Appendix E diversity monitoring form (Word, 311 KB, opens in a new window)

Part 2: The documents we need

Please make sure you send us all the documents listed below as well as your completed forms.

About the applicant

• A copy of your birth certificate or other evidence of your identity.
• A copy of your Criminal Records Bureau disclosure.
• A recent passport-sized photograph of you.
• A copy of your up-to-date CV.
• Certificates or other suitable evidence of your relevant professional qualifications.
• A medical report filled in by your doctor using our standard form (Appendix B medical reference form).
• A filled-in financial reference using our standard form (Appendix C financial reference form), commenting on your financial position.

About the service

• The service's statement of purpose, as set out in the relevant regulations (see our regulations page for details).
• A business plan for the service.
• A copy of the latest two annual accounts.
• A copy of a certificate of insurance to cover employer's liability and public liability.
• A copy of insurance arrangements for the premises.
• If relevant, a copy of the lease of the premises of the establishment or agency.
• Details of the accommodation (for example, a plan).
• Information that is specific to your service (appendix A).
• The registration fee and form (appendix D fees form).
• If relevant, the manager's application form (form R3 - M manager's application form) and all necessary documents.