CIS self-employed registration form

About You
Title*
Name

First NameMiddle NameLast Name
Date of Birth *

DayMonthYear
Gender
National Insurance Number: eg. AB123456C*
Job title *
Nationality*
Do you require a work Permit?*

NoYes
Home Telephone Number
Mobile Number*
Email address*
Professional qualifications held:
Permanent address:*
Town/city: *
Country:*
Postcode:*
Mailing address (if different from above):
Town/city:
Country:
Postcode:
Payment Details
Name of bank/building society:*
Branch location:
Sort code*
Account number*
Roll number (if applicable):
Name of account holder:*
CIS Status & UTR Details
Unique tax reference number (UTR)*
(Sole traders only)
CIS account name
Trading name
Are you VAT register?*

YesNo
Agency Details
Agency name*
Branch location
Contact telephone number*
Name of consultant*
Agency start date*

DayMonthYear
About the Assignment
Is the assignment?*

UK basedAbroadOffshore
How long will the assignment last?*

0-3 months3-6 months6-9 months9months+
How would you classify the assignment? (*If Medical, please also submit details in section 11)*

TradeTechnicalProfessionalRail+Medical
Next of Kin Details
Next of kin name*
Mobile number :*
Home telephone number
Please tick this box if you would like to nominate your next of kin to be able to speak on your behalf at times regarding personal information such as your payments.
7 How did you hear about us?

AgencyColleague/WorkmatePreviously used usOnlineCommunications (e.g. advertising)
Signature

Clear
Date

MonthDayYear
Medical
Please complete the following section if contracting within the medical sector only.
General Medical Council (GMC)
General Medical Council (GMC) PIN*
General Dental Council (GDC)
General Dental Council (GDC) PIN*
Health and Care Professions Council (HCPC)
Health and Care Professions Council (HCPC) PIN*
Nursing and Midwifery Council (NMC)
Nursing and Midwifery Council (NMC) PIN*
Please tick all memberships that apply and provide your PIN numbers where applica
10. KYC Documents

We require KYC documents to confirm you are eligible to work in the UK. Include one of the following with your registration:
- Your original passport or a photocopy countersigned by a professional or manager. Countersigned passports must clearly show the image, passport details and the signature. The person countersigning your passport copy must provide their full name, job title and date of signature.
- A national identity Proof of Address – Please provide any one document - Council tax bill, a copy of utility bill, Driver’s License or Correspondence from HMRC card photocopy countersigned by a professional or manager.
If you do not have a passport and you are a British or Irish national please provide the following:
- A full birth certificate and a recent HMRC document.
11. Declaration
- I understand that Sprypay holds data about me for certain purposes, including (but not limited to), confirming entitlement to work in the UK, managing personnel and pay records as judiciously required to operate its business. I understand that I can request and have access to this data (subject to applicable exclusions) by contacting Sprypay via post or by emailing to info@sprypay.co.uk.
- By signing this application form, I provide my consent to the processing of my personal and /or sensitive personal data as described above. Further, I approve to such data being released to third parties (such as insurance providers/payroll processing) where necessary for the foregoing purposes.
- By signing below, I agree to Sprypay providing references on my behalf to future employers or third parties.
- I agree for Sprypay to check my personal data and qualifications to work in specific areas, where these are required for compliance with legislation.
- I agree that all the data supplied on this form is correct and true to the best of my knowledge.
- I consent to keep Sprypay informed in writing of any changes in my personal details, contact details and any changes in my personal circumstances which might affect my immigration status and eligibility to work in the UK and to supply any such information on request.
- I agree to provide on request documents and information which will enable Sprypay to make any necessary lawful checks on my eligibility to work in the UK.
- Please note we conduct Anti-Money Laundering (AML) check of your Identity and Address proofs submitted to us for compliance purposes.
I understand and provide my consent for the same.
Signature

Clear
Date

MonthDayYear
12. Self-employed Assessment

This assessment is required to enable Sprypay to assess your self-employment status and determine that you are not under Supervision, Direction and Control

Please answer all of the following questions in respect to your services, whether by reference to Sprypay, the agency or the client.
Job Title*
Length of time in role:*
Qualifications: *
Please describe the role to be undertaken for the assignment (general duties only):*
How many assignments have you completed in the last 12 months using your UTR No?: *
As a self-employed sub-contractor ....
Would you be entitled to Holiday pay, sick pay, a company pension schemeor other such benefits?*

YesNo
Are you responsible to complete, either yourself or via an accountant, an annual self-assessment tax return?*

YesNo
Are you responsible for all your own expenses in relation to travellingto/from site and/or overnight accommodation?*

YesNo
Are you under any obligation to accept or receive future assignments from the Agency?*

YesNo
Do you have the freedom to contract on more than one assignment at anyone time and choose the hours you work taking into account assignment deadlines and opening hours of the client’s site*

YesNo
Once given basic instructions of what to do for your day, will anyone else advise you how to complete these tasks?*

YesNo
Will you be under constant supervision by anyone whilst undertaking yourrole?*

YesNo
Do you understand that a suitably qualified alternative contractor can be supplied as a substitute to complete a task that you have been assigned to,should you be unavailable for any reason?*

YesNo
Do you provide your own tools, equipment and/or PPE to carry out your assignments?*

YesNo
Please provide details
Do you receive training with the exception of H&S training from anyone you currently provide services to?*

YesNo
Please provide details
“I acknowledge that the responses I have provided in this questionnaire are a true and accurate description. The responses I have given apply to terms and conditions of my engagement with Sprypay.”
Full Name*
Signature*

Clear
Date*

MonthDayYear
Contact Number*
Should be Empty:

About You

Payment Details

CIS Status & UTR Details

Agency Details

About the Assignment

Next of Kin Details

Medical