Membership Application Form

This form should be completed electronically if possible. Potential Members can adjust the space provided for their answers. If completing on paper, please attach separate sheets for your answers, especially for questions marked “*”.

Submission Instructions:

• Attach your company logo, IN PNG FORMAT

• Return the completed form by email to network@exsusglobal.com.

• Annual membership fee: GBP 500.00, payable upon acceptance. Any additional branches of the same company the fee is GBP 100 per branch.

File Upload*

Please upload your Firms logo

Name*

First NameLast Name

Name of Firm*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

example@example.com

Website Address*

LinkedIn*

Cellular Number*

Work Number

VAT Registration Number

Categories of Work*

Office branches*

YesNo

Branch Office Address*

If you selected No on the previous box please put NONE as your answer

Firm Profile*

To help the Board assess potential synergy with Exsus, please provide a 150-200 words description of your*. This should cover general and specialist areas of work, philosophy of firm, future developments / plans / goals and any other relevant or significant information.

Do you speak fluent English*

YesNo

Main Contact at Exsus*

Is the firm insured against liability for negligence?*

YesNo

What level of cover do you normally disclose to third parties? (Please state currency and equivalent in Euros.)*

Date of Signature*

Date

Signature*

Data Privacy Notice:

The information you provide in this form will be used solely for your membership with Exsus.

EXSUS has a Data Privacy Policy which can be found at EXSUS Privacy Policy. Your data will be stored and only used in accordance with this policy. Your personal data is not passed on by us for use by any other third parties. Full information about how we look after your data, including how you can see what data we hold about you, how you can limit its use, and how you can ask for inaccuracies in data to be corrected, may be found on our Privacy Policy page.

EXSUS takes the privacy of our members’ data seriously and will only use your personal information in compliance with the General Data Protection Regulation (GDPR). We will use the data you have provided on this form for membership administration purposes and for communicating with you about your membership, supplying information, member benefits, and the organisation of events and training courses. The information will be stored in our membership database (which may be stored online in compliance with the GDPR). Only authorised personnel have will be able to access your details.

As an affiliate member of EXSUS, your contact information will be posted on our website and this information can be updated or removed by contacting us at network@exsusinternational.com. Your data may be processed by Mailchimp, who administer our e-newsletter and act as Data Processors on our behalf. They may only use it for the specific purposes for which they act as our data processors and they are not free to pass this on to other organisations that are not connected with EXSUS.

We confirm we have been informed about the provisions of the General Regulation for the protection of personal data 679/2016 (GDPR) and the Privacy Policy of EXSUS and we give the free, specific, explicit and full consent to EXSUS, for the processing of our personal data for the purpose of membership and networking.

We understand that we can resign from our membership by sending an e-mail to network@exsusglobal.com and our Personal Data will then be erased, except where EXSUS has a clear justification to retain such Personal Data.

EXSUS Global Network