Guardianship Preliminary Member Application Form Please enable JavaScript in your browser to complete this form. - Step 1 of 8Before completing this application form, please read carefully the criteria for becoming a Guardianship Provider Member of AGPI. Please click here to see the criteria and tick the boxes below confirming your agreement. Before completing the application form, please confirm: *I have read and agree to the above criteria for becoming a member I can upload with this application, a copy of my tax clearance numberI can upload with this application, an auditor's letter confirming my company is solvent and in good standingI agree to send a €250 non-refundable application fee to the bank details provided, and that if my application is successful, this will be deducted from my annual membership feeIf this application is accepted by AGPI, I agree to being inspected by IGI and to pay an inspection fee every three years in the region of €2500-€3000I accept that there will an annual membership subscription fee of €750ContinueIs the Company / Guardianship Organisation legally registered in Ireland? *YesNoIs there a bond in place as required by Irish company law? *YesNoSorry your organisation is not eligible to join AGPI at this timeWebsite / URLTrading Name (if different)Trading Address Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryContact personFirstLastEmailEmailConfirm EmailWebsite / URLPhonePreviousContinueGOVERNANCEPlease indicate the legal structure of the company.Private Company Limited by Shares (LTD) Private Company Limited by Shares (LTD) Designated Activity Company (DAC) Company Limited by Guarantee (CLG) Public Limited Company (PLC) Limited Partnership Company (LP) Sole TraderCRO Registration NumberDate of IncorporationCRO listed Company Address Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDoes the company have more than one Director?YesNoPlease list all Company Directors below NameAddressEmail *EU ResidentYesNoOther Active Directorships (please list) Do you need to add another director?YesNoNameAddressEmail *EU ResidentYesNoOther Active Directorships (please list)Do you need to add another director?YesNoNameAddressEmail *EU ResidentYesNoOther Active Directorships (please list)Is beneficial ownership of the company applying for membership vested entirely in these directors? YesNoPlease give details of the beneficial owner(s) below: Are any of the Directors or Beneficial Owners listed above disqualified from being a Director? YesNoName of Director (s) or Beneficial Owner (s) - Details re disqualificationPreviousContinueTAX COMPLIANCEWhat is the company Tax Year? Start monthJanuaryJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberEnd monthJanuaryJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear of most recent company accounts filed? 20212021202020192018201720162015201420132012201120102009200820072006200520042003200220012000Is the company fully tax compliant? YesNoPlease provide with this application form: Please upload a print out from ROS of your Tax Clearance number for the most recent tax year of the company Click or drag a file to this area to upload. Please upload a letter from your auditor or accountant certifying that the company is solvent and in good standing with the authorities in Ireland. Click or drag a file to this area to upload. PreviousContinueSTAFFING OF GUARDIANSHIP PROGRAMME How many staff in your organisation are involved in your Guardianship programme? 1-51-56-1011-2021+Have all staff working with minors been Garda vetted?YesNoHave all staff working with minors completed Child Protection Training?YesNo (minimum free online TUSLA “Introduction to Children First” E-learning Programme)Is one member of staff a Designated Liaison Person?YesNoPreviousContinueSTUDENTSNumber of students currently in the care of your Guardianship Programme? 1-51-56-1011-2021-3031-5051+Number of students in Host Family Accommodation 1-51-56-1011-2021-3031-5051+ Number of students in Boarding Accommodation 1-51-56-1011-2021-3031-5051+PreviousContinueINSURANCEInsurance CompanyPolicy number Public Liability Insurance – Limit of Indemnity Employers’ Liability Insurance – Limit of Indemnity Is your current insurance cover adequate?YesNoPreviousContinueI declare that the information provided by me on the above form is true and correct to the best of my knowledge and belief. I also confirm that in the event any information provided by me is not true and complete, AGPI will be within its right to take action including but not limited to refusal of membership or discontinuation of the company's registration as an accredited member. GDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry and I have read, understand and accept all Terms and Conditions and Privacy Policy *SignatureClear SignaturePreviousSign up