Voluntary Licensing Scheme for Agents
Application Form
(February 2010)
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Application History
1st application
Please indicate whether this is your:
Personal Information
Title:
First/preferred name:
Surname:
Date of birth:
Contact Details
Current address:
Correspondence address:
Daytime telephone number:
Fax number:
Mobile number:
Email address:
Employment Information
Employment status:
Job title:
Employer name (if applicable):
Employer address:
Brief description of current duties/responsibilities:
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Re-application
Nature of Role
Sponsorship Agent
Agent
Other:
Aquatics Experience
Please give details of previous aquatics (swimming, synchro, open water, masters, diving, water
polo) experience:
Do you hold a financial or employment interest in any club, association or federation related to the
aquatic disciplines?
Yes
No
If yes, please provide full details of role, name of club/organisation and relevant dates:
Agents Experience
Have you conducted any agency activity in the past two years?
Yes
No
If yes, please provide full details:
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Character and Reputation
As part of the Licensing process, you are required to make the following declarations (please tick
against those that are true). Please Note: that an Enhanced CRB Disclosure certificate will be
required of all Applicants who are successful at this stage.
I have not been convicted of a criminal offence or received a police caution (Note: if you do have
any prior convictions or police cautions, please provide full details below. All prior convictions or
police cautions will be considered in line with the British Swimming’s general policy.)
I am not aware of any pending criminal prosecutions or police charges against me.
I agree to complete a CRB Enhanced Disclosure check for British Swimming as part of this
application process and on a three year periodic basis thereafter (and also if requested to do so at
any other time by British Swimming).
I am not subject to a disqualification order as a director of a registered company under the
Company Directors’ Disqualification Act 1986 (as amended) or under the legislation of any other
jurisdiction.
I am not subject to a ban by a sports governing body from involvement in the administration of a
sport, including a prohibition from working as a sports agent.
I am not subject to a prohibition or restriction from working with children and young people or
vulnerable adults.
I am not subject to a Bankruptcy Order, Interim Bankruptcy Order or a Bankruptcy Restriction
Order.
I have not in the previous 10 years been sanctioned by any regulatory or professional
organisation in relation to professional and/or business activities.
I am not subject to disqualification or striking-off by a professional body including for example
(and without limitation), The Law Society, Bar Council or The institute of Chartered Accountants of
England and Wales.
I am of good character and professional reputation.
I am not subject to any order under section 429(2)(b) of the Insolvency Act 1986 as a result of
failing to make payment required by an administrative order.
If you are unable to confirm any of the above declarations, please set out below which one(s) you
cannot confirm and the reasons why:
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Please Note: In the event that any information provided herein or in the course of holding the Licence is
found to be untrue or misleading or any relevant information omitted, British Swimming reserves the right to
withdraw or withhold the Licence.
Consent to Details on the Website
In the event that a Licence is granted by British Swimming, I give permission for my name and
professional contact details to be listed on the British Swimming website.
Yes
No
If yes, please provide a professional address to be listed if it is different from that of the employer
above:
Data Protection Statement
British Swimming/the Amateur Swimming Association (“ASA”) will use your personal data for the
purpose of your involvement in the Athlete Agent Licensing Scheme.
I understand that by submitting this form, I am consenting to receiving information about the Athlete
Agent Licensing Scheme by post, email, SMS/MMS, online or phone unless stated otherwise.
Consent: I am consenting to receiving information about the ASA / British Swimming initiatives from
the ASA / British Swimming and their commercial partners by post, email, SMS/MMS, online or
phone unless I tell you otherwise.
Opt outs: You have the right to refuse direct marketing and can do so by ticking the relevant
box(es) below.
No thank you, I don’t want British Swimming / the ASA to send me details of products
services.
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No thank you, I don’t want British Swimming / the ASA to send me details of events.
No thank you, I don’t want British Swimming / the ASA to send me details from British
Swimming / the ASA’s commercial partners
Signed:
Date:
Signature
Signed:
Dated:
Please return your completed application to:
Voluntary Licensed Scheme for Agents
c/o Department of Legal Affairs
British Swimming
SportPark
3 Oakfield Drive
Loughborough
Leicestershire
LE11 3QF
Should you be including any confidential documents, please ensure that your correspondence is sent
Recorded Delivery.
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