Form MN1 - UK Border Agency - the Home Office

Section 5: Referees and IdentityPlease write the child’s name and date of birth on the back of a photograph of him/her.This should then be glued or pasted into the space aside.This part of the form is to be filled in by the child’s referees once the child’s photographhas been affixed aside as explained above. The referees should read page 25 of theguide to confirm that they are eligible. Checks will be carried out to ensure that refereesmeet the requirements below and their signatures are genuine, and we may contactthem as part of our enquiries.Affixpassportsize photoSee page 25of the guideName of applicant5.1 Each referee should know the child personally. One referee should be aprofessional whohas engaged with the child inaprofessional capacity, such asateacher, health visitor,social worker or minister of religion. The other referee must normally be the holder of aBritish citizen passport andeither aprofessional person or over the age of25(but see also page 25 of the guide).Referees must:• not be arelative, solicitor or agent ofthe applicant;• not be related to the other referee;• not be employed by the Home Office;• not have been convicted of an imprisonable offence during the last 10years (unless that conviction can bedisregarded in line with the table shown on page 25 of the Guide MN1)• have known the applicant personally;• be willing to give full details of their knowledge of the applicant;• advise the Home Office ofany reason why the applicant should not be registered.1st Referee declaration2nd Referee declarationI declare that Iam qualified to act as referee. TheIdeclare that Iam qualified toact as referee. Thephotograph above isatrue likeness of the applicant. I photograph above is atrue likeness of the applicant. Iconfirm each of the points in 5.1 above. Iconfirm that to confirm each of the points in 5.1 above. I confirm that tothe best of my knowledge the details given onpage 3of the best of my knowledge the details given onpage 3ofthis form are correct.this form are correct.5.2 Say how you know the child and state either your 5.2 Say how you know the child and state either yourage oryour professionage oryour profession5.3 1st Referee full name 5.3 2nd Referee full name5.4 Sex Male Female 5.4 Sex Male Female5.5 Address 5.5 AddressIf you have been at this address for less than 3years If you have been at this address for less than 3yearsplease list previous addresses on page 14. please list previous addresses on page 14.5.6 Daytime telephone number 5.6 Daytime telephone number5.7 e-mail address 5.7 e-mail address5.8 Current British citizen passport number 5.8 Current British citizen passport numberI understand that Imay be liable for prosecution resultingin a penalty of up to 3 months imprisonment orafine notexceeding £5,000 or both ifIknowingly or recklesslymake afalse declaration.Signature of refereeDateI understand that Imay be liable for prosecution resultingin apenalty ofupto3months imprisonment or afine notexceeding £5,000 or both if Iknowingly or recklesslymake afalse declaration.Signature ofrefereeDate15