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P. 175
Notification of Pre-Assessment Checklist
• All sections of this form must be completed.
• Use one form per family, per adult or per child as necessary.
• THIS INFORMATION IS SENT IN CONFIDENCE AND IS RESTRICTED. IT MUST NOT BE PASSED ON
TO A THIRD PARTY WITHOUT THE EXPRESS PERMISSION OF THE POLICE.
OCU Ref.
Subject's details 18PAC130616 (ACN)
Surname: CORDELL
Forename(s): SIMON
Crimlnt
ID Code: 3 Date and place of birth: 26/01/1981 Trace [ ] No Trace [ ]
Home Address:
109 Burncroft Avenue
ENFIELD Enfield
Middlesex
EN37JQ
UNITED KINGDOM
Tel. No. PNC Check
Trace [ ] No Trace [ ]
Current Location: Tel. No.
PNC ID No.
Family and Key Roles Details
Surname Forename(s) DOB/Age Now Relationship
Reporting Officer (Source) Supervising Officer (Certifying actions and
evaluations as correct)
Signature Rank Signature Rank
Name (Print) GEORGIOU OCU/Unit YE-OPS Name (Print) OCU/Unit
Warrant No. P241909
Date 31/05/2018 Date
18PAC130616 Printed for Warrant No. P226743 DATA PROTECTION ACT - DISPOSE OF AS CONFIDENTIAL WASTE
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