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\levelspace360\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4320\jclisttab\tx4320 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0
\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5040\jclisttab\tx5040 }{\listlevel\levelnfc23\levelnfcn23
\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5760\jclisttab\tx5760 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6480\jclisttab\tx6480 }
{\listname ;}\listid1401126699}{\list\listtemplateid-1170069372\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3
\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li720\jclisttab\tx720 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers
;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li1440\jclisttab\tx1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698693
\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2160\jclisttab\tx2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext
\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2880\jclisttab\tx2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360
\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li3600\jclisttab\tx3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1
\levelspace360\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4320\jclisttab\tx4320 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0
\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5040\jclisttab\tx5040 }{\listlevel\levelnfc23\levelnfcn23
\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5760\jclisttab\tx5760 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6480\jclisttab\tx6480 }
{\listname ;}\listid1514416786}{\list\listtemplateid-1453545888\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelnorestart\levelspace360\levelindent0{\leveltext\leveltemplateid-1195590678
\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li1080\jclisttab\tx1080 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext
\leveltemplateid134807555\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li1800\jclisttab\tx1800 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0
{\leveltext\leveltemplateid134807557\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2520\jclisttab\tx2520 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1
\levelspace360\levelindent0{\leveltext\leveltemplateid134807553\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li3240\jclisttab\tx3240 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0
\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid134807555\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li3960\jclisttab\tx3960 }{\listlevel\levelnfc23\levelnfcn23\leveljc0
\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid134807557\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4680\jclisttab\tx4680 }{\listlevel\levelnfc23
\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid134807553\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5400\jclisttab\tx5400 }
{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid134807555\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6120
\jclisttab\tx6120 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace360\levelindent0{\leveltext\leveltemplateid134807557\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 
\chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6840\jclisttab\tx6840 }{\listname ;}\listid1535732928}}{\*\listoverridetable{\listoverride\listid576473857\listoverridecount0\ls1}{\listoverride\listid1514416786\listoverridecount0\ls2}
{\listoverride\listid1401126699\listoverridecount0\ls3}{\listoverride\listid548103567\listoverridecount0\ls4}{\listoverride\listid13046397\listoverridecount0\ls5}{\listoverride\listid638264617\listoverridecount0\ls6}{\listoverride\listid1535732928
\listoverridecount0\ls7}{\listoverride\listid1203055040\listoverridecount0\ls8}}{\*\revtbl {Unknown;}}{\info{\title  }{\author OMBC}{\operator PC14528}{\creatim\yr2007\mo7\dy31\hr14\min35}{\revtim\yr2007\mo7\dy31\hr14\min35}{\printim\yr2007\mo1\dy9\hr10\min7}{\version2}
{\edmins0}{\nofpages8}{\nofwords1715}{\nofchars9780}{\*\company OMBC}{\nofcharsws12010}{\vern8203}}\paperw11906\paperh16838\margl540\margr566\margt540\margb360 
\widowctrl\ftnbj\aenddoc\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\formshade\horzdoc\dgmargin\dghspace180\dgvspace180\dghorigin540\dgvorigin540\dghshow1\dgvshow1
\jexpand\viewkind1\viewscale75\pgbrdrhead\pgbrdrfoot\splytwnine\ftnlytwnine\htmautsp\nolnhtadjtbl\useltbaln\alntblind\lytcalctblwd\lyttblrtgr\lnbrkrule \fet0\sectd \linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl {\*\pnseclvl1
\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}}{\*\pnseclvl5
\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang
{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth4608 \cellx4500\clvertalt\clcbpat1\cltxlrtb\clftsWidth3\clwWidth6480 \cellx10980\pard\plain \s15\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f29\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f28\fs96\cf1\lang2057\langfe1033\langnp2057 CAF FORM
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\cf1 \cell }\pard\plain \s15\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\f29\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs12\cf8\lang2057\langfe1033\langnp2057 
\par }{\f1\cf8\lang2057\langfe1033\langnp2057 *IMPORTANT*
\par A copy of the completed CAF form }{\f1\ul\cf8\lang2057\langfe1033\langnp2057 must}{\f1\cf8\lang2057\langfe1033\langnp2057  be sent to:
\par Gerard Gudgion CAF Co-ordinator
\par }\pard\plain \qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf8 Unit 10 Whitney Court, Southlink Business Park
\par Oldham OL4 1DB
\par Tel: 0161 770 6672\cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth4608 \cellx4500\clvertalt\clcbpat1\cltxlrtb\clftsWidth3\clwWidth6480 \cellx10980\row }\trowd 
\trgaph108\trrh718\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain 
\s24\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \f1\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f0\lang2057\langfe1033\langnp2057 
\par }\pard\plain \s15\qc \li0\ri-108\sa390\sl280\slmult0\widctlpar\intbl\faauto\rin-108\lin0 \f29\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\i\f1\fs20\cf1 Notes for use: If you are completing form electronically, text boxes
 will expand to fit your text Where check boxes appear, insert an \lquote X\rquote  in those that apply.\cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\f1\cf1 \trowd \trgaph108\trrh718\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\trowd 
\trgaph108\trrh1243\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain 
\s16\qj \li0\ri0\sa325\widctlpar\intbl\faauto\rin0\lin0 \f484\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f1\cf1 Identifying details 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\i\f1\fs20\cf1 Record details of unborn baby, infant, child or young person being assessed. If unborn, state name as \lquote unborn baby
\rquote  and \line mother\rquote s name, e.g. unborn baby of Ann Smith.}{\f1\fs20\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trrh1243\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Name\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\fldedit{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }AKA}{\f1\fs16\cf1\super 1}{\f1\fs20\cf1 /previous names\nestcell{\nonesttables
\par }{\*\bkmkstart Text10}}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text10}}}}}{\fldrslt {
\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 {\*\bkmkend Text10}\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrt\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Male\nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1 {\*\bkmkstart Check1} FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}
}{\fldrslt }}{\f1\fs20\cf1 {\*\bkmkend Check1}        Female   }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1 {\*\bkmkstart Check2} FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check2}\ffdefres0}}}}{\fldrslt }}{\f1\fs20\cf1 {\*\bkmkend Check2}        Unknown   }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1 {\*\bkmkstart Check3} FORMCHECKBOX }{\f1\fs20\cf1 
{\*\datafield 650000001400000006436865636b3300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check3}\ffdefres0}}}}{\fldrslt }}{\f1\fs20\cf1 {\*\bkmkend Check3}\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }Date of birth or EDD}{\f1\fs16\cf1\super 2}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }{\*\bkmkstart Text11}}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text11}}}}}{\fldrslt {
\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 {\*\bkmkend Text11}\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Address\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\fldedit{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Contact tel. no.\nestcell{\nonesttables
\par }{\*\bkmkstart Text12}}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text12}}}}}{\fldrslt {
\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 {\*\bkmkend Text12}\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Unique ref. no.\nestcell{\nonesttables
\par }{\*\bkmkstart Text13}}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {
\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 {\*\bkmkend Text13}\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Version no.\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 
\cellx8294\clvertalt\clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Postcode\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Religion\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\clbrdrt\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294\clvertalt
\clbrdrt\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft14\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx1094\clvertalt\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5594\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5954\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8294
\clvertalt\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10828\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 {
\b\f1\cf1 Ethnicity}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 White British \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1 {\*\bkmkstart Check4} FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}
}{\fldrslt }}{\f1\fs20\cf1 {\*\bkmkend Check4}\nestcell{\nonesttables
\par }Caribbean \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }Indian \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 White & Black 
\par Caribbean
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }Chinese\nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1593 \cellx1601\clvertalt\cltxlrtb\clftsWidth3\clwWidth552 \cellx2153\clvertalt\cltxlrtb\clftsWidth3\clwWidth1589 \cellx3742\clvertalt\cltxlrtb\clftsWidth3\clwWidth555 \cellx4297
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1764 \cellx6061\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx6507\clvertalt\cltxlrtb\clftsWidth3\clwWidth1756 \cellx8263\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx8709
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1575 \cellx10284\clvertalt\cltxlrtb\clftsWidth3\clwWidth553 \cellx10837\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 White Irish 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 African 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Pakistani 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 White & Black
\par African
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Any other  
\par ethnic group*
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1593 \cellx1601\clvertalt\cltxlrtb\clftsWidth3\clwWidth552 \cellx2153\clvertalt\cltxlrtb\clftsWidth3\clwWidth1589 \cellx3742\clvertalt\cltxlrtb\clftsWidth3\clwWidth555 \cellx4297
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1764 \cellx6061\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx6507\clvertalt\cltxlrtb\clftsWidth3\clwWidth1756 \cellx8263\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx8709
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1575 \cellx10284\clvertalt\cltxlrtb\clftsWidth3\clwWidth553 \cellx10837\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Any other White 
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 background*\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Any other Black 
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 background*\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Bangladeshi 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 White & Asian 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 
\par }\pard \ql \fi720\li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Not given 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trrh773\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1593 \cellx1601\clvertalt\cltxlrtb\clftsWidth3\clwWidth552 \cellx2153\clvertalt\cltxlrtb\clftsWidth3\clwWidth1589 \cellx3742\clvertalt\cltxlrtb\clftsWidth3\clwWidth555 \cellx4297
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1764 \cellx6061\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx6507\clvertalt\cltxlrtb\clftsWidth3\clwWidth1756 \cellx8263\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx8709
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1575 \cellx10284\clvertalt\cltxlrtb\clftsWidth3\clwWidth553 \cellx10837\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 Any other Asian background*}{\f1\cf1 \nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Any other mixed background* 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 
\par }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth4289 \cellx4297\clvertalt\cltxlrtb\clftsWidth3\clwWidth1764 \cellx6061\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx6507\clvertalt\cltxlrtb\clftsWidth3\clwWidth1756 \cellx8263
\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx8709\clvertalt\cltxlrtb\clftsWidth3\clwWidth2128 \cellx10837\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth2875 \cellx2883\clvertalt\clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2700 \cellx5583\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\cltxlrtb\clftsWidth3\clwWidth2345 \cellx8288\clvertalt
\clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 *If other, please specify\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Immigration status\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2875 \cellx2883\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2700 \cellx5583\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2345 \cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth2875 \cellx2883\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2700 \cellx5583\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\cltxlrtb\clftsWidth3\clwWidth2345 
\cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Child\rquote s first language\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Parent\rquote s first language\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2875 \cellx2883\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2700 \cellx5583\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2345 \cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth2875 \cellx2883\clvertalt\cltxlrtb\clftsWidth3\clwWidth2700 \cellx5583\clvertalt\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\cltxlrtb\clftsWidth3\clwWidth2345 \cellx8288
\clvertalt\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Does the child have a disability?
\par }\pard \qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 \nestcell{\nonesttables
\par }}\pard \qr \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Yes\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 \nestcell{\nonesttables
\par }}\pard \qr \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 No\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth3219 \cellx3227\clvertalt\cltxlrtb\clftsWidth3\clwWidth561 \cellx3788\clvertalt\cltxlrtb\clftsWidth3\clwWidth540 \cellx4328\clvertalt\cltxlrtb\clftsWidth3\clwWidth683 \cellx5011
\clvertalt\cltxlrtb\clftsWidth3\clwWidth446 \cellx5457\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 If \lquote yes\rquote  give details\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx2348\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth8460 \cellx10808
\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard\plain 
\s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Is an interpreter or signer required?
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }Yes }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }No }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Has this been arranged?
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }Yes }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }No }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth3420 \cellx3428\clvertalt\cltxlrtb\clftsWidth3\clwWidth1080 \cellx4508\clvertalt\cltxlrtb\clftsWidth3\clwWidth1980 \cellx6488\clvertalt\cltxlrtb\clftsWidth3\clwWidth2520 \cellx9008
\clvertalt\cltxlrtb\clftsWidth3\clwWidth900 \cellx9908\clvertalt\cltxlrtb\clftsWidth3\clwWidth900 \cellx10808\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Details of any special requirements
\par (for child and/or their parent)
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3960 \cellx3968\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth6840 \cellx10808
\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 {\f1\fs14\cf1 1 \lquote Also known as\rquote 
\par }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs14\cf1 2 Expected date of delivery}{\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\page 
\par }\trowd \trgaph108\trrh712\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain 
\s16\qj \li0\ri0\sa325\widctlpar\intbl\faauto\rin0\lin0 \f484\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\lang2057\langfe1033\langnp2057 \page }{\b\f1\cf1 Assessment information}{\f1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trrh712\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 People present
\par at assessment
\par }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trrh1074\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2160 \cellx2168\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth8640 \cellx10808
\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 {
\f1\fs20\cf1 What has led to this unborn baby, infant, child or young person being assessed?\line \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trrh1059\trleft5\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth10800 \cellx10805\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trrh1249\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\f1\cf1  }{\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd 
\trgaph108\trrh1249\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\b\f1\cf1 Details of parents/carers
\par }{\f1\cf1  \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 Name\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Contact tel. no.\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth900 \cellx908\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675 \cellx5583\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1625 \cellx7568\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth3254 \cellx10822\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Relationship to unborn baby, infant, child or young person\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5580 \cellx5588\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4984 \cellx10572\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth236 \cellx10808\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Address\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Parental responsibility?\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh330\trleft8\trkeep\trftsWidth3\trwWidth12960\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmgf\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvmgf\clvertalt\clbrdrl\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1800 \cellx7388\clvertalt\cltxlrtb\clftsWidth3\clwWidth3240 
\cellx10628\clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx12968\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Yes }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }No }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh495\trleft8\trkeep\trftsWidth3\trwWidth12960\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1800 \cellx7388\clvertalt\cltxlrtb\clftsWidth3\clwWidth1440 
\cellx8828\clvertalt\cltxlrtb\clftsWidth3\clwWidth1800 \cellx10628\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx12968\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 Name\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Contact tel. no.\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth900 \cellx908\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675 \cellx5583\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1625 \cellx7568\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth3254 \cellx10822\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Relationship to unborn baby, infant, child or young person\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5580 \cellx5588\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4984 \cellx10572\clvertalt\clbrdrl
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth236 \cellx10808\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Address\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Parental responsibility?\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh330\trleft8\trkeep\trftsWidth3\trwWidth12960\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmgf\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvmgf\clvertalt\clbrdrl\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1800 \cellx7388\clvertalt\cltxlrtb\clftsWidth3\clwWidth3240 
\cellx10628\clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx12968\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Yes }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }No }{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1  FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}\ffdefres0}}}}{\fldrslt }}{
\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh495\trleft8\trkeep\trftsWidth3\trwWidth12960\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1800 \cellx7388\clvertalt\cltxlrtb\clftsWidth3\clwWidth1440 
\cellx8828\clvertalt\cltxlrtb\clftsWidth3\clwWidth1800 \cellx10628\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx12968\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 {
\b\f1\cf1 Current family and home situation\line 
\par }{\f1\fs20\cf1 (e.g. Family circumstances and history, family structure including siblings, other significant adults etc; who lives with the child and who does not live with the child)
\par \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 
00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 
\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trrh4109\trleft5\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth10800 \cellx10805\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\row }\pard \ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\cf1 
\par }\pard \qc \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs28\cf1 2
\par \page 
\par }\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0 {
\b\f1\cf1 Details of person(s) undertaking assessment}{\b\f1\cf1 
\par }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 Name\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Contact tel. no.\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth900 \cellx908\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4675 \cellx5583\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5943\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1625 \cellx7568\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth3254 \cellx10822\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Address\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Role\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text12}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmgf\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588
\clvertalt\clbrdrl\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth360 \cellx5948\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5948\clvertalt\cltxlrtb\clftsWidth3\clwWidth2340 \cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }Organisation\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\clvertalt\clbrdrl\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth360 \cellx5948\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2340 \cellx8288\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth2534 \cellx10822\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh240\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trwWidthA5234\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd 
\trgaph108\trrh240\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trwWidthA5234\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvmrg\clvertalt\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1080 \cellx1088\clvmrg\clvertalt
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4500 \cellx5588\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trrh717\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trrh717\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 
\cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard \ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Name of lead professional (where applicable)\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4320 \cellx4328\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth6244 \cellx10572
\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\ql \li0\ri0\widctlpar\intbl\faauto\rin0\lin0\itap2 {\f1\fs20\cf1 Lead professional\rquote s contact number\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4320 \cellx4328\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth6244 \cellx10572
\nestrow}{\nonesttables
\par }}\trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\pard\plain \s18\ql \li0\ri0\sl280\slmult0
\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\fs20\cf1 \trowd \trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 
\clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard\plain \s18\ql \li0\ri0\sl280\slmult0\widctlpar\intbl\faauto\rin0\lin0 \f485\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\fs20\cf1 
\par }\pard\plain \s22\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \b\f1\fs24\lang2057\langfe1033\kerning28\cgrid\langnp2057\langfenp1033 {\cf1\kerning0 Serv
ices working with this infant, child or young person (include services working with family or siblings where appropriate) 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\cf1 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\cf1 \trowd 
\trgaph108\trleft-108\trftsWidth3\trwWidth11088\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\cltxlrtb\clftsWidth3\clwWidth11088 \cellx10980\row }\pard 
\qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\b\f1\fs20\cf1 Universal\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 GP\nestcell{\nonesttables
\par }}{\field\flddirty\fldpriv{\*\fldinst {\f1\fs20\cf1 {\*\bkmkstart Check45} FORMCHECKBOX }{\f1\fs20\cf1 {\*\datafield 650000001400000007436865636b343500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check45}\ffdefres0}}
}}{\fldrslt }}{\f1\fs20\cf1 {\*\bkmkend Check45}\nestcell{\nonesttables
\par }Details\nestcell{\nonesttables
\par }}{\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof 
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }Tel.\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap3 {\field\flddirty{\*\fldinst {\f1\fs20\cf1  FORMTEXT }{\f1\fs20\cf1 {\*\datafield 00000000140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20
}}}}{\fldrslt {\f1\fs20\cf1\lang1024\langfe1024\noproof \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}{\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap3 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trrh486\trleft5\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth1658 \cellx1663\nestrow}{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 
\clvmgf\clvertalt\cltxbtlr\clftsWidth3\clwWidth593 \cellx601\clvertalt\cltxlrtb\clftsWidth3\clwWidth2734 \cellx3335\clvertalt\cltxlrtb\clftsWidth3\clwWidth536 \cellx3871\clvertalt\clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth1190 \cellx5061
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth3188 \cellx8249\clvertalt\clbrdrl\brdrs\brdrw10\brdrcf1 
\cltxlrtb\clftsWidth3\clwWidth694 \cellx8943\clvertalt\cltxlrtb\clftsWidth3\clwWidth1889 \cellx10832\nestrow}{\nonesttables
\par }}\pard \qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\b\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 
\clvmrg\clvertalt\cltxlrtb\clftsWidth3\clwWidth593 \cellx601\clvertalt\cltxlrtb\clftsWidth3\clwWidth2734 \cellx3335\clvertalt\cltxlrtb\clftsWidth3\clwWidth536 \cellx3871\clvertalt\clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth1190 \cellx5061
\clvmrg\clvertalt\clbrdrl\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3188 \cellx8249\clvertalt\clbrdrl\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth939 \cellx9188
\clvertalt\cltxlrtb\clftsWidth3\clwWidth1644 \cellx10832\nestrow}{\nonesttables
\par }}\pard \qc \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\b\f1\fs20\cf1 \nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 \nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }\nestcell{\nonesttables
\par }}\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 {\f1\fs20\cf1 {\*\nesttableprops\trowd \trgaph108\trleft8\trkeep\trftsWidth1\trftsWidthB3\trftsWidthA3\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 
\clvmrg\clvertalt\cltxlrtb\clftsWidth3\clwWidth593 \cellx601\clvertalt\cltxlrtb\clftsWidth3\clwWidth2734 \cellx3335\clvertalt\cltxlrtb\clftsWidth3\clwWidth536 \cellx3871\clvertalt\cltxlrtb\clftsWidth3\clwWidth1190 \cellx5061\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf1 \clbrdrb\brdrs\brdrw10\brdrcf1 \cltxlrtb\clftsWidth3\clwWidth3188 \cellx8249\clvertalt\cltxlrtb\clftsWidth3\clwWidth939 \cellx9188\clvertalt\cltxlrtb\clftsWidth3\clwWidth1644 \