Register

Register

When completing this registration form, we kindly ask you to fill in all the provided fields in block capitals. Please do not hesitate to call us on 01536 659 064 should you require assistance.

After submitting the form you will receive a confirmation email. If you have not received this please get in touch with our Enquiries Team enquiries@pureumbrella.com or call us on 01536 601 530.

SECTION 1 - NAME AND CONTACT DETAILS

Title:* First Name:* Surname:*
Maiden Surname: Other Name(s):
Marital Status:* Date of Birth (DD/MM/YYYY):*
House Number/Name:* Address Line 1:*
Address Line 2: Town:*
Postcode:* County:*
Email:* Telephone: Mobile:*
Preferred Contact:*

At least one contact number must be supplied.

SECTION 2 - FINANCIALS

Bank Name:* Account Name:*
Account No:* Sort Code:*

Enter your eight digit Account No (12345678) and six digit Sort-Code (123456), excluding any dashes or hyphens.

National Insurance Number:

SECTION 3 - AGENCY/END CLIENT CONTRACT DETAILS

Section 3 relates to the contract you have either with the agency of end client

1. Agency Details

Agency Name: Contact Name:
Agency Email: Agency Contact Phone:
End Client Name:
Contract Start Date (DD/MM/YYYY): Contract End Date (DD/MM/YYYY):
Rate of Pay Per Hour (£): Number of Contracted Hours Per Week:

2. Agency Details

Agency Name: Contact Name:
Agency Email: Agency Contact Phone:
End Client Name:
Contract Start Date (DD/MM/YYYY): Contract End Date (DD/MM/YYYY):
Rate of Pay Per Hour (£): Number of Contracted Hours Per Week:

3. Agency Details

Agency Name: Contact Name:
Agency Email: Agency Contact Phone:
End Client Name:
Contract Start Date (DD/MM/YYYY): Contract End Date (DD/MM/YYYY):
Rate of Pay Per Hour (£): Number of Contracted Hours Per Week:

4. Agency Details

Agency Name: Contact Name:
Agency Email: Agency Contact Phone:
End Client Name:
Contract Start Date (DD/MM/YYYY): Contract End Date (DD/MM/YYYY):
Rate of Pay Per Hour (£): Number of Contracted Hours Per Week:

YOUR IDENTITY AND RIGHT TO WORK IN THE UK

As an employer we are required to make basic checks on everyone we intend to employ and you will be required to supply the relevant right to work documents.

Under the terms of the Immigration, Asylum and Nationality Act 2006, we have a responsibility to prevent illegal working in the UK by ensuring that our employees have the right to work in the UK.

We will require the following documents to verify your identity and prove your right to work in the UK. You can view the full list here.

  • Identification - Passport
  • Residence - Utility Bill, Bank Statement, Council Tax Bill/Statement, Mortgage or Rent Statement, Tenancy Agreement
  • Right to Work - Visa/Work Permit, Home Office

CONSENT

By completing and submitting this application you are authorising a member of SRM Payroll to contact you/and the agency regarding the completion of your registration.

Full Name:* Date (DD/MM/YYYY):*