FORM: LoP APPLICATION(VERSION1)

Suffolk Family Information Service

Suffolk County Council List of Providers (LoP) Application Form

This form can be used to join Suffolk County Council’s List of Providersto offer funded Early Education to all 3 & 4 year olds and eligible 2 year olds. It can also be used to update bank details, or to be removed from the List of Providers.

This form must be completed electronically and submitted via email to . Hand written forms cannot be accepted.

SECTION 1: TYPE OF REQUEST AND DECLARATION / Select one option
OPTION 1 - I would like to join Suffolk County Council’s List of Providers.
I confirm that I have read,understood,and agree to all the requirements of being a member of Suffolk County Council’s List of Providers. You will find these at > EYFS Resources > List Of Providers Info & Updates > Become an LoP Member.
I confirm that the details I will provide in Section 2 of this form are the same as thoseregistered with Ofsted.
Please complete pages 1 and 2 of this form in full.
OPTION 2 - I would like to change my bank details.
I confirm that the bank account details I will provide in Section 3 are correct and I would like any future funding to be paid into this account.
Please complete pages 1 and 2 of this form in full.
OPTION 3 - I would like to be immediately removedfrom Suffolk County Council’s List of Providers.
I confirm that I would like to be permanently removed from the List of Providers with immediate effect.I understand that this means I can no longer offer funded Early Education for 3 & 4 year olds and eligible 2 year olds. If I ever want to re-join the List of Providers I understand that a new application will have to be completed in full.
I confirm that I understand that any overpayment I have received will be reclaimed.
Please only complete Section 1 and Section 4 of this form.
DECLARATION – I confirm that I understand and agree to the Option selected above. I understand that my email address will act as evidence of date and electronic signature once I have submitted this form.
Certifiers Full Name:
Certifiers Job Title:
Registered Childcare Provider Name:
Date:
SECTION 2: REGISTERED CHILDCARE PROVIDER’S DETAILS (Complete in full)
Registered Childcare Provider Address:
Business Contact Telephone Number:
Business Contact Email Address:
Ofsted Unique Reference Number (URN):
Judgement of most recent Ofsted Inspection: / Date of most recent Ofsted Inspection:
SECTION 3: BANK DETAILS (Complete in full)
Bank Account Name:
Sort Code:
Bank Account Number:
Bank Name:
Bank Address:
SECTION 4: ADDITIONAL COMMENTS
You can also use this box to inform us of any additional information you think maybe necessary.
If you have selected Option 3 it would be helpful for us to know why you have chosen to be removed from the List of Providers.

THIS PAGE IS FOR SUFFOLK COUNTY COUNCIL OFFICE USE ONLY

FAMILY INFORMATION SERVICE USE ONLY
FIS Operator Initials: / Date Form Received:
InfoLink Contact ID:
Cluster:
EARLY YEARS AND CHILDCARE CLUSTER USE ONLY
Staff Allocated To: / Date Allocated:
Initial Phone Call Made By: / Date of Call:
Outcome of First Call:
Initial Pre-LoP Joining Visit Booked: / Date of Visit:
Not Joining: / Joining:
(to start from next term) / Fast Track: (currently has eligible funded children)
FINANCE USE ONLY
Dated Joined to LoP: / SEEGs Number:
FAMILY INFORMATION SERVICE ONLY (date and initial to confirm)
Evince DS Flash Added: / Evince DS SEEG’s Number Added:
Evince DS funding ticks added: / Added to PSG:

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