HiddenDate DD slash MM slash YYYY Name* First Last Email* Enter Email Confirm Email Is this your first quarterly development objectives meeting?* Yes No Have all previously agreed objectives been achieved on time?*Please select your answer...Yes - all objectives have been achievedPartial - one or more objectives were achievedNo objectives were achievedPlease provide a brief explanation for why one or more of the previously agreed objectives have not been achieved*Development Objective 1Category*Select a category...Excellence Review MeetingAdditional Qualifications and/or trainingWider Professional Knowledge (Safeguarding & Prevent, EDI & GDPR)Technology SkillsOtherExcellence in Teaching Rubric - Category*Select a rubric category...Expectations & AttitudesWider Knowledge & Professional DutiesSubject & Course Knowledge, Understanding & ApplicationOrganisational Skills, Planning & SequencingSkills & CharacteristicsPersonalisationAssessmentProgress & ImpactExpectations & Attitudes - Main Criteria*Which criteria does this objective relate to? Expectations & Attitudes in general i) I have the highest expectations of myself and my learners. ii) I am clearly motivated to achieve the best outcomes for all my learners. iii) I model professional behaviours and expect the same of my learners. iv) I am committed to Equality, Diversity and Inclusion and expect the same commitment from my learners. v) I establish excellent professional relationships with all of my learners. vi) My learners are engaged and positive about all aspects of their course, including Skills for Business. vii) I have empathy and care for my learners. viii) I celebrate successes with my learners and employers. Wider Knowledge & Professional Duties - Main Criteria*Which criteria does this objective relate to? Wider Knowledge & Professional Duties in general i) I embody the core values of Corndel. ii) I fully understand and accept my responsibilities for my learners’ progress, and their timely completion of assignments and EPA. iii) I support my learners to ensure they have sufficient resources, opportunities and time to successfully complete in a timely manner. iv) I am persistent in encouraging employers to attend Q Reviews and to be actively involved in the learner’s course and progress. v) I am fully aware and accept my responsibilities concerning Safeguarding, Prevent and Br. Values, Data Protection and GDPR. vi) I and my learner understand the referral and escalation processes for safeguarding or wellbeing concerns. vii) I am fully committed to my own Continuing Professional Development. Subject & Course Knowledge, Understanding & Application - Main Criteria*Which criteria does this objective relate to? Subject & Course Knowledge, Understanding & Application in general i) I am an expert in my field. ii) I am committed to maintaining up-to-date, industry standard expertise in my field. iii) I consistently demonstrate thorough, relevant and contextualised subject knowledge. iv) I promote the importance and development of English and maths skills as essential for the course, learners’ careers and lives. v) I demonstrate a thorough understanding of my course, its structure, content and assessment requirements. vi) I know and understand the prescribed Knowledge, Skills and Behaviours for the Apprenticeship Standard. vii) I use Aptem accurately and effectively to evidence compliance and achievement. viii) I give excellent and impartial Information Advice and Guidance to my learners. Organisational Skills, Planning & Sequencing - Main Criteria*Which criteria does this objective relate to? Organisational Skills, Planning & Sequencing in general i) I have coherent plans for the organisation and sequencing of learning. ii) I plan for the development of the prescribed Knowledge, Skills and Behaviours of the Apprenticeship Standard. iii) I am thoroughly prepared, organised, and punctual for each session. iv) I provide an agenda in advance, with clear and agreed objectives. v) My sessions are well structured, effective and promote progress. vi) I utilise the ‘RAN’ (Recap, Apply, New learning) approach in my planning and delivery. vii) I am flexible with my structure and show confidence in changing the agenda or plan, taking a situational approach to best meet the needs of my learners. viii) I agree SMART targets and aspirational goals for each session. ix) I plan for and/or respond to opportunities to promote Safeguarding, Prevent, &/or Br. Values. Skills & Characteristics - Main Criteria*Which criteria does this objective relate to? Skills & Characteristics in general i) I have excellent communication skills. ii) I sensitively control the pace of the session to ensure maximum learning. iii) I encourage active participation, ensuring the learner has the majority input. iv) I empower the learner to describe, analyse, and evaluate their own learning. v) I enable the learner to understand how they learn best. vi) I skilfully employ a range of questioning techniques to progress learning. vii) I practice active listening and respond effectively. viii) I confidently and appropriately utilise technology. ix) I encourage reflection and independent thinking. Personalisation - Main Criteria*Which criteria does this objective relate to? Personalisation in general i) I know my learners well, and plan, resource and deliver to best meet their individual needs. ii) I seize opportunities to challenge and stretch my learners. iii) I personalise the learning according to any neurodiversity and/or additional learning needs. iv) I take into account the individual circumstances of each learner, including workload and wellbeing, and adapt sessions to ensure they make progress and achieve, displaying flexibility and confidence in changing the agenda in a situational approach. v) I tailor the learning to support my learner’s career goals and aspirations. vi) I contextualise the learning to my learner’s role, employer and industry. vii) I effectively use the learner’s skills scan and ILP to plan and shape the sessions, and to set SMART targets. viii) I am committed to inclusion, making reasonable adjustments and applying for any access arrangements. Assessment - Main Criteria*Which criteria does this objective relate to? Assessment in general i) My understanding and application of the assessment criteria are excellent. ii) I use a range of approaches, including questioning, to assess progress in every session and amend plans accordingly. iii) I skilfully employ formative and summative activities, including questioning to assess my learners. iv) I provide insightful feedback to my learners which develops their understanding. v) I assess my learner’s English and maths development, provide the necessary support, (including S4B involvement where appropriate). vi) My marking is accurate and completed in a timely fashion, providing the learner with specific guidance on how to improve. vii) My learners’ assignments meet the required success criteria and standard expected. viii) I accurately forecast EPA readiness for all my learners, ensuring they complete on time. Progress & Impact - Main Criteria*Which criteria does this objective relate to? Progress & Impact in general i) My learners make excellent progress through the course. ii) My learner’s progress is significant in each session, evidenced in Aptem and at Quarterly Reviews. iii) My learners have full ownership of their ILP, and an understanding of their progress against the course expectations and milestones. iv) Feedback from my learners and their employers is consistently excellent. v) My learners achieve at EPA and other professional qualifications (where relevant), to an excellent standard. vi) My learners achieve within the expected timeframe. vii) My learners experience personal and professional development, promotion and/or progression within their roles or employment. viii) My cohorts of learners achieve well, contributing to excellent Qualification Achievement Rates (QAR) for Corndel. Other category* Priority*Select the priority...High priorityMedium priorityLow priorityObjective 1*Development Objective 2Category*Select a category...Excellence Review MeetingAdditional Qualifications and/or trainingWider Professional Knowledge (Safeguarding & Prevent, EDI & GDPR)Technology SkillsOtherExcellence in Teaching Rubric - Category*Select a rubric category...Expectations & AttitudesWider Knowledge & Professional DutiesSubject & Course Knowledge, Understanding & ApplicationOrganisational Skills, Planning & SequencingSkills & CharacteristicsPersonalisationAssessmentProgress & ImpactExpectations & Attitudes - Main Criteria*Which criteria does this objective relate to? Expectations & Attitudes in general i) I have the highest expectations of myself and my learners. ii) I am clearly motivated to achieve the best outcomes for all my learners. iii) I model professional behaviours and expect the same of my learners. iv) I am committed to Equality, Diversity and Inclusion and expect the same commitment from my learners. v) I establish excellent professional relationships with all of my learners. vi) My learners are engaged and positive about all aspects of their course, including Skills for Business. vii) I have empathy and care for my learners. viii) I celebrate successes with my learners and employers. Wider Knowledge & Professional Duties - Main Criteria*Which criteria does this objective relate to? Wider Knowledge & Professional Duties in general i) I embody the core values of Corndel. ii) I fully understand and accept my responsibilities for my learners’ progress, and their timely completion of assignments and EPA. iii) I support my learners to ensure they have sufficient resources, opportunities and time to successfully complete in a timely manner. iv) I am persistent in encouraging employers to attend Q Reviews and to be actively involved in the learner’s course and progress. v) I am fully aware and accept my responsibilities concerning Safeguarding, Prevent and Br. Values, Data Protection and GDPR. vi) I and my learner understand the referral and escalation processes for safeguarding or wellbeing concerns. vii) I am fully committed to my own Continuing Professional Development. Subject & Course Knowledge, Understanding & Application - Main Criteria*Which criteria does this objective relate to? Subject & Course Knowledge, Understanding & Application in general i) I am an expert in my field. ii) I am committed to maintaining up-to-date, industry standard expertise in my field. iii) I consistently demonstrate thorough, relevant and contextualised subject knowledge. iv) I promote the importance and development of English and maths skills as essential for the course, learners’ careers and lives. v) I demonstrate a thorough understanding of my course, its structure, content and assessment requirements. vi) I know and understand the prescribed Knowledge, Skills and Behaviours for the Apprenticeship Standard. vii) I use Aptem accurately and effectively to evidence compliance and achievement. viii) I give excellent and impartial Information Advice and Guidance to my learners. Organisational Skills, Planning & Sequencing - Main Criteria*Which criteria does this objective relate to? Organisational Skills, Planning & Sequencing in general i) I have coherent plans for the organisation and sequencing of learning. ii) I plan for the development of the prescribed Knowledge, Skills and Behaviours of the Apprenticeship Standard. iii) I am thoroughly prepared, organised, and punctual for each session. iv) I provide an agenda in advance, with clear and agreed objectives. v) My sessions are well structured, effective and promote progress. vi) I utilise the ‘RAN’ (Recap, Apply, New learning) approach in my planning and delivery. vii) I am flexible with my structure and show confidence in changing the agenda or plan, taking a situational approach to best meet the needs of my learners. viii) I agree SMART targets and aspirational goals for each session. ix) I plan for and/or respond to opportunities to promote Safeguarding, Prevent, &/or Br. Values. Skills & Characteristics - Main Criteria*Which criteria does this objective relate to? Skills & Characteristics in general i) I have excellent communication skills. ii) I sensitively control the pace of the session to ensure maximum learning. iii) I encourage active participation, ensuring the learner has the majority input. iv) I empower the learner to describe, analyse, and evaluate their own learning. v) I enable the learner to understand how they learn best. vi) I skilfully employ a range of questioning techniques to progress learning. vii) I practice active listening and respond effectively. viii) I confidently and appropriately utilise technology. ix) I encourage reflection and independent thinking. Personalisation - Main Criteria*Which criteria does this objective relate to? Personalisation in general i) I know my learners well, and plan, resource and deliver to best meet their individual needs. ii) I seize opportunities to challenge and stretch my learners. iii) I personalise the learning according to any neurodiversity and/or additional learning needs. iv) I take into account the individual circumstances of each learner, including workload and wellbeing, and adapt sessions to ensure they make progress and achieve, displaying flexibility and confidence in changing the agenda in a situational approach. v) I tailor the learning to support my learner’s career goals and aspirations. vi) I contextualise the learning to my learner’s role, employer and industry. vii) I effectively use the learner’s skills scan and ILP to plan and shape the sessions, and to set SMART targets. viii) I am committed to inclusion, making reasonable adjustments and applying for any access arrangements. Assessment - Main Criteria*Which criteria does this objective relate to? Assessment in general i) My understanding and application of the assessment criteria are excellent. ii) I use a range of approaches, including questioning, to assess progress in every session and amend plans accordingly. iii) I skilfully employ formative and summative activities, including questioning to assess my learners. iv) I provide insightful feedback to my learners which develops their understanding. v) I assess my learner’s English and maths development, provide the necessary support, (including S4B involvement where appropriate). vi) My marking is accurate and completed in a timely fashion, providing the learner with specific guidance on how to improve. vii) My learners’ assignments meet the required success criteria and standard expected. viii) I accurately forecast EPA readiness for all my learners, ensuring they complete on time. Progress & Impact - Main Criteria*Which criteria does this objective relate to? Progress & Impact in general i) My learners make excellent progress through the course. ii) My learner’s progress is significant in each session, evidenced in Aptem and at Quarterly Reviews. iii) My learners have full ownership of their ILP, and an understanding of their progress against the course expectations and milestones. iv) Feedback from my learners and their employers is consistently excellent. v) My learners achieve at EPA and other professional qualifications (where relevant), to an excellent standard. vi) My learners achieve within the expected timeframe. vii) My learners experience personal and professional development, promotion and/or progression within their roles or employment. viii) My cohorts of learners achieve well, contributing to excellent Qualification Achievement Rates (QAR) for Corndel. Other category* Priority*Select the priority...High priorityMedium priorityLow priorityObjective 2*Development Objective 3Category*Select a category...Excellence Review MeetingAdditional Qualifications and/or trainingWider Professional Knowledge (Safeguarding & Prevent, EDI & GDPR)Technology SkillsOtherExcellence in Teaching Rubric - Category*Select a rubric categoryExpectations & AttitudesWider Knowledge & Professional DutiesSubject & Course Knowledge, Understanding & ApplicationOrganisational Skills, Planning & SequencingSkills & CharacteristicsPersonalisationAssessmentProgress & ImpactExpectations & Attitudes - Main Criteria*Which criteria does this objective relate to? Expectations & Attitudes in general i) I have the highest expectations of myself and my learners. ii) I am clearly motivated to achieve the best outcomes for all my learners. iii) I model professional behaviours and expect the same of my learners. iv) I am committed to Equality, Diversity and Inclusion and expect the same commitment from my learners. v) I establish excellent professional relationships with all of my learners. vi) My learners are engaged and positive about all aspects of their course, including Skills for Business. vii) I have empathy and care for my learners. viii) I celebrate successes with my learners and employers. Wider Knowledge & Professional Duties - Main Criteria*Which criteria does this objective relate to? Wider Knowledge & Professional Duties in general i) I embody the core values of Corndel. ii) I fully understand and accept my responsibilities for my learners’ progress, and their timely completion of assignments and EPA. iii) I support my learners to ensure they have sufficient resources, opportunities and time to successfully complete in a timely manner. iv) I am persistent in encouraging employers to attend Q Reviews and to be actively involved in the learner’s course and progress. v) I am fully aware and accept my responsibilities concerning Safeguarding, Prevent and Br. Values, Data Protection and GDPR. vi) I and my learner understand the referral and escalation processes for safeguarding or wellbeing concerns. vii) I am fully committed to my own Continuing Professional Development. Subject & Course Knowledge, Understanding & Application - Main Criteria*Which criteria does this objective relate to? Subject & Course Knowledge, Understanding & Application in general i) I am an expert in my field. ii) I am committed to maintaining up-to-date, industry standard expertise in my field. iii) I consistently demonstrate thorough, relevant and contextualised subject knowledge. iv) I promote the importance and development of English and maths skills as essential for the course, learners’ careers and lives. v) I demonstrate a thorough understanding of my course, its structure, content and assessment requirements. vi) I know and understand the prescribed Knowledge, Skills and Behaviours for the Apprenticeship Standard. vii) I use Aptem accurately and effectively to evidence compliance and achievement. viii) I give excellent and impartial Information Advice and Guidance to my learners. Organisational Skills, Planning & Sequencing - Main Criteria*Which criteria does this objective relate to? Organisational Skills, Planning & Sequencing in general i) I have coherent plans for the organisation and sequencing of learning. ii) I plan for the development of the prescribed Knowledge, Skills and Behaviours of the Apprenticeship Standard. iii) I am thoroughly prepared, organised, and punctual for each session. iv) I provide an agenda in advance, with clear and agreed objectives. v) My sessions are well structured, effective and promote progress. vi) I utilise the ‘RAN’ (Recap, Apply, New learning) approach in my planning and delivery. vii) I am flexible with my structure and show confidence in changing the agenda or plan, taking a situational approach to best meet the needs of my learners. viii) I agree SMART targets and aspirational goals for each session. ix) I plan for and/or respond to opportunities to promote Safeguarding, Prevent, &/or Br. Values. Skills & Characteristics - Main Criteria*Which criteria does this objective relate to? Skills & Characteristics in general i) I have excellent communication skills. ii) I sensitively control the pace of the session to ensure maximum learning. iii) I encourage active participation, ensuring the learner has the majority input. iv) I empower the learner to describe, analyse, and evaluate their own learning. v) I enable the learner to understand how they learn best. vi) I skilfully employ a range of questioning techniques to progress learning. vii) I practice active listening and respond effectively. viii) I confidently and appropriately utilise technology. ix) I encourage reflection and independent thinking. Personalisation - Main Criteria*Which criteria does this objective relate to? Personalisation in general i) I know my learners well, and plan, resource and deliver to best meet their individual needs. ii) I seize opportunities to challenge and stretch my learners. iii) I personalise the learning according to any neurodiversity and/or additional learning needs. iv) I take into account the individual circumstances of each learner, including workload and wellbeing, and adapt sessions to ensure they make progress and achieve, displaying flexibility and confidence in changing the agenda in a situational approach. v) I tailor the learning to support my learner’s career goals and aspirations. vi) I contextualise the learning to my learner’s role, employer and industry. vii) I effectively use the learner’s skills scan and ILP to plan and shape the sessions, and to set SMART targets. viii) I am committed to inclusion, making reasonable adjustments and applying for any access arrangements. Assessment - Main Criteria*Which criteria does this objective relate to? Assessment in general i) My understanding and application of the assessment criteria are excellent. ii) I use a range of approaches, including questioning, to assess progress in every session and amend plans accordingly. iii) I skilfully employ formative and summative activities, including questioning to assess my learners. iv) I provide insightful feedback to my learners which develops their understanding. v) I assess my learner’s English and maths development, provide the necessary support, (including S4B involvement where appropriate). vi) My marking is accurate and completed in a timely fashion, providing the learner with specific guidance on how to improve. vii) My learners’ assignments meet the required success criteria and standard expected. viii) I accurately forecast EPA readiness for all my learners, ensuring they complete on time. Progress & Impact - Main Criteria*Which criteria does this objective relate to? Progress & Impact in general i) My learners make excellent progress through the course. ii) My learner’s progress is significant in each session, evidenced in Aptem and at Quarterly Reviews. iii) My learners have full ownership of their ILP, and an understanding of their progress against the course expectations and milestones. iv) Feedback from my learners and their employers is consistently excellent. v) My learners achieve at EPA and other professional qualifications (where relevant), to an excellent standard. vi) My learners achieve within the expected timeframe. vii) My learners experience personal and professional development, promotion and/or progression within their roles or employment. viii) My cohorts of learners achieve well, contributing to excellent Qualification Achievement Rates (QAR) for Corndel. Other category* Priority*Select the priority...High priorityMedium priorityLow priorityObjective 3*Would you like to add any more objectives at this stage?* Yes No Additional Development ObjectiveCategory*Select a category...Excellence Review MeetingAdditional Qualifications and/or trainingWider Professional Knowledge (Safeguarding & Prevent, EDI & GDPR)Technology SkillsOtherExcellence in Teaching Rubric - Category*Select a rubric category...Expectations & AttitudesWider Knowledge & Professional DutiesSubject & Course Knowledge, Understanding & ApplicationOrganisational Skills, Planning & SequencingSkills & CharacteristicsPersonalisationAssessmentProgress & ImpactExpectations & Attitudes - Main Criteria*Which criteria does this objective relate to? Expectations & Attitudes in general i) I have the highest expectations of myself and my learners. ii) I am clearly motivated to achieve the best outcomes for all my learners. iii) I model professional behaviours and expect the same of my learners. iv) I am committed to Equality, Diversity and Inclusion and expect the same commitment from my learners. v) I establish excellent professional relationships with all of my learners. vi) My learners are engaged and positive about all aspects of their course, including Skills for Business. vii) I have empathy and care for my learners. viii) I celebrate successes with my learners and employers. Wider Knowledge & Professional Duties - Main Criteria*Which criteria does this objective relate to? Wider Knowledge & Professional Duties in general i) I embody the core values of Corndel. ii) I fully understand and accept my responsibilities for my learners’ progress, and their timely completion of assignments and EPA. iii) I support my learners to ensure they have sufficient resources, opportunities and time to successfully complete in a timely manner. iv) I am persistent in encouraging employers to attend Q Reviews and to be actively involved in the learner’s course and progress. v) I am fully aware and accept my responsibilities concerning Safeguarding, Prevent and Br. Values, Data Protection and GDPR. vi) I and my learner understand the referral and escalation processes for safeguarding or wellbeing concerns. vii) I am fully committed to my own Continuing Professional Development. Subject & Course Knowledge, Understanding & Application - Main Criteria*Which criteria does this objective relate to? Subject & Course Knowledge, Understanding & Application in general i) I am an expert in my field. ii) I am committed to maintaining up-to-date, industry standard expertise in my field. iii) I consistently demonstrate thorough, relevant and contextualised subject knowledge. iv) I promote the importance and development of English and maths skills as essential for the course, learners’ careers and lives. v) I demonstrate a thorough understanding of my course, its structure, content and assessment requirements. vi) I know and understand the prescribed Knowledge, Skills and Behaviours for the Apprenticeship Standard. vii) I use Aptem accurately and effectively to evidence compliance and achievement. viii) I give excellent and impartial Information Advice and Guidance to my learners. Organisational Skills, Planning & Sequencing - Main Criteria*Which criteria does this objective relate to? Organisational Skills, Planning & Sequencing in general i) I have coherent plans for the organisation and sequencing of learning. ii) I plan for the development of the prescribed Knowledge, Skills and Behaviours of the Apprenticeship Standard. iii) I am thoroughly prepared, organised, and punctual for each session. iv) I provide an agenda in advance, with clear and agreed objectives. v) My sessions are well structured, effective and promote progress. vi) I utilise the ‘RAN’ (Recap, Apply, New learning) approach in my planning and delivery. vii) I am flexible with my structure and show confidence in changing the agenda or plan, taking a situational approach to best meet the needs of my learners. viii) I agree SMART targets and aspirational goals for each session. ix) I plan for and/or respond to opportunities to promote Safeguarding, Prevent, &/or Br. Values. Skills & Characteristics - Main Criteria*Which criteria does this objective relate to? Skills & Characteristics in general i) I have excellent communication skills. ii) I sensitively control the pace of the session to ensure maximum learning. iii) I encourage active participation, ensuring the learner has the majority input. iv) I empower the learner to describe, analyse, and evaluate their own learning. v) I enable the learner to understand how they learn best. vi) I skilfully employ a range of questioning techniques to progress learning. vii) I practice active listening and respond effectively. viii) I confidently and appropriately utilise technology. ix) I encourage reflection and independent thinking. Personalisation - Main Criteria*Which criteria does this objective relate to? Personalisation in general i) I know my learners well, and plan, resource and deliver to best meet their individual needs. ii) I seize opportunities to challenge and stretch my learners. iii) I personalise the learning according to any neurodiversity and/or additional learning needs. iv) I take into account the individual circumstances of each learner, including workload and wellbeing, and adapt sessions to ensure they make progress and achieve, displaying flexibility and confidence in changing the agenda in a situational approach. v) I tailor the learning to support my learner’s career goals and aspirations. vi) I contextualise the learning to my learner’s role, employer and industry. vii) I effectively use the learner’s skills scan and ILP to plan and shape the sessions, and to set SMART targets. viii) I am committed to inclusion, making reasonable adjustments and applying for any access arrangements. Assessment - Main Criteria*Which criteria does this objective relate to? Assessment in general i) My understanding and application of the assessment criteria are excellent. ii) I use a range of approaches, including questioning, to assess progress in every session and amend plans accordingly. iii) I skilfully employ formative and summative activities, including questioning to assess my learners. iv) I provide insightful feedback to my learners which develops their understanding. v) I assess my learner’s English and maths development, provide the necessary support, (including S4B involvement where appropriate). vi) My marking is accurate and completed in a timely fashion, providing the learner with specific guidance on how to improve. vii) My learners’ assignments meet the required success criteria and standard expected. viii) I accurately forecast EPA readiness for all my learners, ensuring they complete on time. Progress & Impact - Main Criteria*Which criteria does this objective relate to? Progress & Impact in general i) My learners make excellent progress through the course. ii) My learner’s progress is significant in each session, evidenced in Aptem and at Quarterly Reviews. iii) My learners have full ownership of their ILP, and an understanding of their progress against the course expectations and milestones. iv) Feedback from my learners and their employers is consistently excellent. v) My learners achieve at EPA and other professional qualifications (where relevant), to an excellent standard. vi) My learners achieve within the expected timeframe. vii) My learners experience personal and professional development, promotion and/or progression within their roles or employment. viii) My cohorts of learners achieve well, contributing to excellent Qualification Achievement Rates (QAR) for Corndel. Other category* Priority*Select the priority...High priorityMedium priorityLow priorityAdditional Objective*The date (maximum 3 months time) when these objectives will be reviewed is...*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature*Date of signing* DD slash MM slash YYYY