Position
Name (block Capitals)
Signature
Date

Internal Verifier**

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Given name

Family name (block
Candidate
Candidate signature
Date
(block capitals) capitals) Registrationl

enrolment

number

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Unit Summary Sheet
Assessment and Verification Declaration
Qcr title: Health & Social Care
Unit no~,:).ksc ........, ~..6~~
Candidate declaration:
I confirm that the evidence listed for this unit is authentic and a true representation of my own work. Candidate name: _OO :D..ts.V.LCS _ .. Candidate enrolment number: f:t .. f?:. .. ~.WQ. .. s..S ~ . Candidate signature: :;:ztzs::::J Date: 6...1e/.I"3
Assessor declaration:
I confirm that this candidate has achieved all the requirements of this unit with the evidence listed. (Where there is more than one assessor, the co-ordinating assessor for the unit should sign this declaration.)
Assessment was conducted under the specified conditions and context, and is valid, aut.hen t i c , reliab~ .c~ ~~
~v~... . .. _ _ _ _ _ _ .. Assessor Sign~ ~ Date: k.'..~ ·1 .?
"--s:: __ Count~~ture: (if relevant) _ _ _ _... Date: .. _ .
(E"or starf workin~~s the e e sessee qualification)
Internal verifier Declaration:
This section to be left blank if sampling of this unit did not take