Contractor registration form
Before commencing any work for ColorKote Limited this form must be completed and signed. All four sections are required, please review the form first to ensure you have all the required information to hand before starting. Thank you.
Company Name (if applicable)
Contractor Name
*
First Name(s)
Last Name
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Mobile Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
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Date of birth
*
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Day
-
Month
Year
National Insurance Number or Company Registration Number
*
UTR Number
*
Bank Account Number (for payments)
*
Sort Code
*
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Emergency Contact Name
*
Emergency Contact Telephone Number
*
Do you experience any of the following symptoms? Please type 'yes' or 'no'. If 'Yes' please give details.
Do you consider yourself 'High Risk' regarding Coronavirus? If 'yes' please give details so that we can discuss control measures to keep you safe.
*
Please indicate YES or NO - If Yes, please provide full details. Further information and a Full list of those falling into the extremely vulnerable group can be found here on the gov website: https://www.gov.uk/government/news/major-new-measures-to-protect-people-at-highest-risk-from-coronavirus
Coughing, wheezing, breathing difficulties, Asthma, Bronchitis, tuberculosis or any other chest disease?
*
Please indicate YES or NO - If Yes, please provide full details
Itching, redness, excessive dryness, or blistering of skin?
*
Please indicate YES or NO - If Yes, please provide full details
Have you been to the doctor in the last year due to any of the above or anything that may be work related?
*
Please indicate YES or NO - If Yes, please provide full details
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GDPR Statement: Please tick this box to give your consent for Colorkote Limited to securely store this information for the following use: - Contact you to offer and arrange work - Make payments into your bank account - Pay over CIS deductions - Contact your next-of-kin in the event of an accident. - Health surveillance (required by law) - Book training courses if required (ColorKote Limited Data Protection policy can be found on our website).
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Please sign the below box to signify that the information provided is complete and true to the best of your knowledge.
Signature
*
Please verify that you are human
*
Submit
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