Disclosure Scheme for Domestic Abuse Scotland

Application Area

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Section 1 - The person at risk

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Complete as much as you know.

Their Previous names

Previous names

Their date of birth

Date of Birth

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / January February March April May June July August September October November December / 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910

Date of birth - person C

Place of birth

Gender - person C

Gender

Please Select Male Female Transgender Prefer not to say

Ethnicity - person C

Ethnicity

Please select White Scottish White other Indian Pakistani Bangladeshi Other South Asian Caribbean African Black Scottish or other black Chinese Other ethnic group Prefer not to say

Address - person C

Address (required)

(required)

Postcode - person C

Postcode

Mobile telephone number - person C

Mobile telephone number

(required)

Landline telephone number - person C

Landline telephone number

(required)

Email address - person C

Email address

(required)

Preferred method of contact - person C

Preferred method of contact

Please Select Email address Landline telephone Mobile phone

How do you know this person - person C

How do you know this person

Section 2 - The person you are requesting information about?

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Previous names - person B

Previous names

Date of Birth - person B

Date of Birth

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / January February March April May June July August September October November December / 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910

Place of birth - person B

Place of birth

Gender - person B

Gender

Please Select Male Female Transgender Prefer not to say

Ethnic origin - person B

Ethnic origin

Please select White Scottish White other Indian Pakistani Bangladeshi Other South Asian Caribbean African Black Scottish or other black Chinese Other ethnic group Prefer not to say

Address - person B

Address

Postcode - person B

Postcode

Any known contact information - person B

Any known contact information

How do you know this person? - person B

How do you know this person?

Section 4 - Children

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Section 5 - Why are you worried?

Section 6 - Safety Questions

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Immediate risk

Do you think there is an immediate risk that the Police should act on quickly? (required)
Please select Yes No

(required)

Does the person know you are making an application?

Does the person you are asking for information about know that you are making this application? (required)
Please select Yes No

(required)

Section 7 - How can we contact you?

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Section 8 - Further Information

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Tick box - Person A

Applying about my own partner.
Please note that once the application is submitted, the process will not be stopped by Police Scotland upon request of the applicant or any other person and in all circumstances will be followed through to its natural conclusion.

Place a 'tick' in this box to indicate that you have understood the above statement. (required)

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Tick box - Person C

Applying about someone else's partner.
Please note that once the process is completed, the person potentially at risk will receive a disclosure of information if this is deemed relevant. You, as the applicant under these circumstances, will not receive information from Police Scotland on the person you identify as 'the partner'.

Place a 'tick' in this box to indicate that you have understood the above statement. (required)

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