Second Referee Details

Dear Glenn, I'm very grateful to you doing this for me, please fill in the form below which are the details about you that I will need to fill in my application form and then there is a declaration form which you will need to sign and write my name etc. in the back of my photograph in your handwriting, which I can either bring it to you to sign or you are more than welcome to come over obviously.

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Personal Details
Address
Lived at this address for more than 3 years?