Care Inspectorate Wales – Bank reference
Individual Applicant 	
Name of Bank		
Address	

Post code		

Applicant details	
Applicant Name		
Address	

Postcode		
Type of service 
(for example care home service, domiciliary support service) 		

I am applying to register to provide a regulated service under the Regulation and Inspection of Social Care (Wales) Act 2016.

As part of the registration process the regulator, Care Inspectorate Wales, requires a bank reference in relation to my financial standing.

I authorise you to provide Care Inspectorate Wales with an opinion as to my financial standing.
 	
Signature		
Print name		
Date		

Important: We process any personal and/or sensitive information we hold about you fairly and lawfully, and we only ask for such information where it is necessary for us to carry out our role. For more information about how we process your personal data, and your rights in relation to this, please see our Privacy Notice at https://careinspectorate.wales/how-we-use-your-information, or contact us for a paper copy.

To be completed by the bank	
Please use the space below to detail the bank’s opinion on the financial standing for the individual/organisation detailed above	
	
Signature	
Print name	
Date	
Bank’s authorisation stamp