Membership form ( Rob )

MEMBERSHIP APPLICATION FORM (1)

Please complete ALL sections of this form IN BLOCK CAPITALS.

Step 1 of 2

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Membership Number:

MEMBERSHIP APPLICATION FORM

Please complete ALL sections of this form IN BLOCK CAPITALS.

Surname:

Title

Forenames:

Date of Birth

Telephone number:

Full Home Address:

Address: Post code:

Full Official Port/Office Address:

Grade:

National Insurance Number:

Work Email address:

Personal Email Address:

Enter Email Confirm Email

* Please note, your direct debit confirmation will be sent to this email address.

Death Benefit Nominee:

The benefit of £3000 is payable to a nominated person if the fully paid up member’s death occurs during his/her employment. This is available to fully paying members up to the age of 70. If the nominee is under the age of 18, a trustee can be nominated. Please contact HQ if you would like a set of rules with govern these payments

Death Benefit Name:

Relationship to you:

Address:

Telephone number:

Please can you confirm that you hold a UK Bank / Building Society Account and you are the Account Holder?

Yes

Please can you confirm that you are the only person required to authorise debits from this Account?

Yes

If you are happy to proceed, please click continue

Continue

Cancel

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If you have answered ‘No’ to to the above question, you will need to complete a paper Direct Debit form. Click here to download

Name of account holder

Bank/building society account number

Branch sort code

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Name of Bank

Bank Name

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Reference

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