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Domestic Violence and Abuse Disclosure Scheme

Application % Completed
Section 1 of 6 Details of the Applicant
Section 2 of 6 Details of person at risk
Section 3 of 6 Details of the Subject
Section 4 of 6 Details of children at address or within relationship
Section 5 of 6 Details of registered interest
Section 6 of 6 Elements of risk

Please confirm before proceeding

Please do not use this form to report a crime

For all emergencies, call 999.

An Incident/Crime is graded as an Emergency if the incident is in progress and in which there is, or is likely to be:

  • a risk to life
  • use or immediate threat of use of violence
  • serious injury caused to a person
  • serious damage caused to property
  • an offender is disturbed at the scene, or has been detained and poses, or is likely to pose a risk to other people

For non emergency, call 101.

I have read and understand that I cannot report a crime/ incident by this means and wish to proceed with the Domestic Violence and Abuse Disclosure Scheme application
Are you the person at risk? *
It is vital that during this initial contact, a safe means of communication is agreed with the applicant where the place, means and timing is determined by the applicant. This is critical to safeguarding of the applicant.

Details of the person at risk if different from the applicant

Address (in full including postcode)

It is vital that during this initial contact, a safe means of communication is agreed with the applicant where the place, means and timing is determined by the applicant. This is critical to safeguarding of the applicant.

Details of the Subject

The more details police have concerning the subject, the easier it will be to carry out necessary police checks.

NOTE if DOB is not provided police may not be able to carry out the appropriate checks.

Address (in full including postcode)

Previous Address (if applicable)

Employer Details


Details of children at address or within the relationship

Are there any children at the address or within the relationship
(including children who live elsewhere)

Details of registered interest

Elements of Risk

Does the subject know you are making this application?*
Are you concerned about the subject knowing you are making this application?*
If you are applying about someone elses partner does that person know that are making this application?*
Do you think there is an immediate risk that Police should act quickly on?*
NB If you believe there is an immediate risk, you should also report this to police immediately via telephone on 999 (in emergencies) or 101 (for non emergencies) or by reporting personally at a police station.

Information to be read by the applicant

The Domestic Violence and Abuse Disclosure Scheme does not replace existing procedures that are currently in place for the Disclosure and Barring Service(DBS), Subject Access or Freedom of Information (FOI) requests, nor does it replace existing Safeguarding Adults procedures. Where an enquiry is made that is unsuitable for the disclosure scheme, Safeguarding Adult procedures may be taken.

Disclosure will only be given to the person at risk and / or the person who is in the best position to safeguard the person at risk from harm.

Relevant checks should be completed by POLICE using the information given in this form. The results of these checks will be used to assess whether there is an immediate or imminent risk of harm to the person at risk from the subject.

Should a decision be made to progress the disclosure application further then this will be referred to the PSNI's Public Protection Team to follow up. There will be a face-to-face discussion with the applicant by a specially trained officer. This should take place no longer than 12 days after the initial contact. You are advised that credible proof of identity will be required at this stage (preferably photo ID such as a passport or driving licence). From this, the necessary checks and risk assessments MUST be completed which will then be discussed at the Decision Making Forum before any disclosure can be made. Other than in exceptional circumstances, applications for disclosure should be completed within 45 days of initial contact.

If any immediate risks are identifed at any stage, then immediate safeguarding action will be taken, including a safety plan delivered by PSNI and partners.

Do you consider yourself at risk from the subject of this inquiry?

If 'Yes', follow the appropriate action to address any concerns and identified risks regarding domestic abuse and personal safety for further information please consult PSNI Domestic abuse information page on the external website.

IN CIRCUMSTANCES WHERE CHILD PROTECTION CONCERNS ARE IDENTIFIED THE INFORMATION WILL BE PASSED TO THE RELEVANT SOCIAL SERVICES TRUST.

By ticking the box below I understand that:
  • If I have wilfully given false or malicious information to the police to try and obtain information about another person, I may be liable to criminal proceedings.
  • Should I receive a subsequent disclosure regarding the person I have enquired about, this will be solely for the purpose of keeping myself and/or my child(ren) safe.
  • I must not share this information with any other person.
  • If I breach this confidentiality, I understand that I may be liable to legal proceedings.
  • I agree that should I receive a disclosure, I will abide by an undertaking to keep this information confidential.
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