Crystal Clear Contract Services Limited Application Form CIS/Sole Trader

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1 CIS/Sole Trader Please sign and complete this form as soon as possible. Until we have processed your application, we cannot pay you. Complete the whole form if you can, BUT YOU MUST COMPLETE ALL AREAS OF THE FORM MARKED WITH * before we can accept your application. Please print in capital letters. Please return completed form to: Crystal Clear Contract Services Limited Suite 2 2 nd Floor 75 Lever Street Manchester M FL YOUR DETAILS *Title: Mr Mrs Ms Miss *First Name: Middle Name: Other (please state) *Last Name: *Date of Birth: *Address: *City: *Post Code: Telephone No: Mobile No: Fax Number: Address: *Nationality: *National Insurance No: *Are you an EU National: Yes No I am not an EU national. I enclose a copy of my work permit Passport Number: Gender: Male Female 2 YOUR BANK OR BUILDING SOCIETY DETAILS *Name of Bank: *Address: *City: Sort Code: *Post Code: Account: *Reference No. (Building Society accounts) Note: If this account is not your own name, we will need permission from the account holder confirming that we can pay your earnings into this account.

2 CIS/Sole Trader AGENCY DETAILS Name of Agency: Agency Contact: Agency Branch: Agency Tel No: Agency Fax No: JOB DETAILS * Job Title: Industry (e.g. Driving, Construction): Hirer Name: Duration of Assignment: Assignment Location: Have you ever worked for this hirer before? Yes / No If Yes, when did you last work for them? / / 5 WHICH SERVICE ARE YOU APPLYING FOR SOLE TRADER CIS (Go to page ) (Go to page 6) 2

3 CIS/Sole Trader VERIFICATION OF IDENTITY AND RIGHT TO WORK We are required to check that you are eligible to work in the UK. Please confirm whether you are a: BIRITISH CITIZEN CITIZEN OF OTHER EUROPEAN ECOMIC AREA (EEA) COUNTRY If so, which one: The following are EEA countries Austria, Belgium, Cyprus,Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Irish Republic, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland CITIZEN OF OTHER COUNTRY If so, which one: To prove that you have the right to take this work, please provide ONE of documents from -6 in List A, OR a document from 7- in List A along with an official document issued by a previous employer or Government agency, e.g. HM Revenue and Customs (formerly the Inland Revenue), the Department for Work and Pensions, Jobcentre Plus, the Training and Employment Agency (Northern Ireland) or the Northern Ireland Social Security Agency, which contains the National Insurance number and name of the person. A P5, P60, National Insurance number card, or a letter from a Government agency demonstrating your National Insurance number is acceptable. IF YOU CANT PROVIDE DOCUMENTS FROM LIST A: Provide ONE of documents - in List B, OR the specified combination of documents in -8 from List B. If your documents are from List B, we will need to make checks every year that you continue to be eligible to work in the UK. If you are having difficulties please contact our Customer Services Department on

4 SOLE TRADER Are you registered with HMRC as self-employed? If yes, what is your Unique Tax Reference (UTR Number)? If no, you will need to register with HMRC by calling the help line on Are you registered for CIS? Are you registered for VAT? If yes, what is you VAT Registration Number (VRN)? Public Liability Insurance All self-employed workers must have their own Public Liability (PL) insurance cover, and you cannot be paid through Crystal Clear Contract Services Limited CIS or Crystal Clear Contract Services Limited Solo unless you have the appropriate cover. PL cover can be provided by Crystal Clear Contract Services Limited (cover up to 5,000,000.) for 2.50 a week if required. Please indicate below if you wish to take this PL cover. If you have your own PL cover we will need to see a copy of the policy. I wish to take out Public Liability insurance cover through Crystal Clear Contract Services Limited, and agree to Crystal Clear Contract Services Limited deducting 2.50 a week, from income due to me. Please tick box. OR I do not wish to take out Public Liability cover through Crystal Clear Contract Services Limited. Details of my existing policy are: Insurance Company: Policy Number: (Please attach a photocopy of the policy details)

5 SOLE TRADER AGREEMENT TO TERMS. I confirm that I have read and understood a copy of Crystal Clear Contract Services Limited s information brochure, and this and I agree to the following Crystal Clear Contract Services Limited terms and conditions. 2. I agree to sign the Self-Employment Contract which I will receive when this form has been processed, and return it to Crystal Clear Contract Services Limited.. I understand that Crystal Clear Contract Services Limited holds information about me for certain purposes, including (but not limited to) administering personnel records and otherwise as reasonably required to operate its business. I understand that I can request access to this information (subject to applicable exemptions) by contacting Crystal Clear Contract Services Limited at the address above.. By signing this application form, I am consenting to the processing of personal data (and sensitive personal data) as described above. Further, I agree to such data being released to third parties where required for their above-mentioned purposes. 5. I agree to keep Crystal Clear Contract Services Limited informed in writing of any changes in my personal details, contact details and any changes in my personal or work circumstances (specifically changes in assignments) which might affect my work status. 6. I agree that all the information supplied on this form is correct and true to the best of my knowledge. Signature: Print Name: Date: 5

6 CIS Are you registered with HMRC as self-employed? If yes, what is your Unique Tax Reference (UTR Number)? If no, you will need to register with HMRC by calling the help line on Are you registered for CIS? Are you registered for VAT? If yes, what is you VAT Registration Number (VRN)? Public Liability Insurance All self-employed workers must have their own Public Liability (PL) insurance cover, and you cannot be paid through Crystal Clear Contract Services Limited CIS or Crystal Clear Contract Services Limited Solo unless you have the appropriate cover. PL cover can be provided by Crystal Clear Contract Services Limited (cover up to 5,000,000.) for 2.50 a week if required. Please indicate below if you wish to take this PL cover. If you have your own PL cover we will need to see a copy of the policy. I wish to take out Public Liability insurance cover through Crystal Clear Contract Services Limited, and agree to Crystal Clear Contract Services Limited deducting 2.50 a week, from income due to me. Please tick box. OR I do not wish to take out Public Liability cover through Crystal Clear Contract Services Limited. Details of my existing policy are: Insurance Company: Policy Number: (Please attach a photocopy of the policy details) 6

7 CIS AGREEMENT TO TERMS. I confirm that I have read and understood a copy of Crystal Clear Contract Services Limited s information brochure, and this and I agree to the following Crystal Clear Contract Services Limited terms and conditions. 2. I agree to sign the Self-Employment Contract which I will receive when this form has been processed, and return it to Crystal Clear Contract Services Limited.. I understand that Crystal Clear Contract Services Limited holds information about me for certain purposes, including (but not limited to) administering personnel records and otherwise as reasonably required to operate its business. I understand that I can request access to this information (subject to applicable exemptions) by contacting Crystal Clear Contract Services Limited at the address above.. By signing this application form, I am consenting to the processing of personal data (and sensitive personal data) as described above. Further, I agree to such data being released to third parties where required for their above-mentioned purposes. 5. I agree to keep Crystal Clear Contract Services Limited informed in writing of any changes in my personal details, contact details and any changes in my personal or work circumstances (specifically changes in assignments) which might affect my work status. 6. I agree that all the information supplied on this form is correct and true to the best of my knowledge. Signature: Print Name: Date: 7

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