solihull.gov.uk

Provider Change of Legal Entity

* CQC Registered Provider name

* CQC Registered Provider ID number (e.g. 1-xxxxxxxxx)

Owner details

* Contact name

Telephone number

* Email

* Postal address

CQC details

If this change effects more than one location under the same provider, you will need to complete a form for each location.

* Current CQC registered location name

* Current CQC registered location ID number (e.g. 1-xxxxxxxxx)

* Have the CQC been notified of the change you are informing us about

* Which of your contracts will this change effect (e.g. care home, supported living, homes support, home support specialism)

Registered manager details

Telephone

* Email

* Postal address

Change of Legal Entity

* Please provide the full new name

* Please provide the full address

* What is the effect date of this change (DD/MM/YYYY)

* Has the new legal entity been registered with the CQC

* If you answered 'Yes', please provide the new CQC Location ID number (This is your CQC Location ID and can be found on your CQC Certificate of Registration next to the heading "Location ID")

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.