Contact Us

Address – Unit 7B Popin Business Centre
South Way Wembley Middlesex HA9 0HF
Contact number – 0203 519 2121
Email Address – hello@benifactsumbrella.co.uk

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Your Contact Details

Title*

As it appears on your passport

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Country*

Preferred method of contact:

Your Details

Date of birth*

Gender*

Nationality*

National Insurance Number*

Profession*

Member of which professional body:*

Professional body registration number*

Do you have professional indemnity cover under MDU/MPS or other?*

Upload proof of professional indemnity cover

If your answer is YES above, please attach a copy

How did you find out about Benifacts Umbrella Services?*

Please provide brief additional details, eg, the name of the colleague who referred you, which agency, where was the advert, which search engine etc.

Additional referral details*

Your Bank Details

Name of bank or building society*

Branch town*

Name of account holder*

Branch sort code*

Bank account/Building society reference number*

Your recruitment agency details

Agency/client 1

Agency/client (1) name*

Agency/client (1) contact person*

Agency/client (1) contact number

Agency/client (1) rate

Agency/client (1) pay interval

Agency/client 2

Please provide details of additional agencies/clients (if applicable):

Agency/client (2) name

Agency/client (2) contact person

Agency/client (2) contact number

Agency/client (2) rate

Agency/client (2) pay interval

Agency/client 3

Please provide details of additional agencies/clients (if applicable):

Agency/client (3) name

Agency/client (3) contact person

Agency/client (3) contact number

Agency/client (3) rate

Agency/client (3) pay interval

Additional agencies/clients

If you work for more than 3 agencies/clients please provide details in the free text box below:

Additional agency/client details

About your employment

Do you have full time employment with any employer, eg, NHS Trust, in the UK?*

Have you undertaken Benifacts Umbrella/contract work at the same hospital/location over the past 24-months or nearing 24-months?*

Do you have a current employer outside of the UK?*

If YES, what is the name of your employer?

Complete if you have selected 'Yes' above

If YES, what is the country of your employer

Complete if you have selected 'Yes' above

Confirmation of your identity and right to work

We need to see an original document with which we can confirm your identity (a passport is acceptable).

We also need to see an original document/s which confirms your right to work in the UK – this could be your passport with a visa stamp or some other form of official document.

Please confirm which document/s you will send to us to confirm your right to work using the list below.

Proof of right to work in the UK

Expiry date of right to work (if relevant)

Your confirmation

I confirm, to the best of my knowledge, that the details contained on this form are accurate and true and that I am entitled to work in the UK. I instruct Benifacts Umbrella Services Ltd to make all necessary enquiries regarding the information for the purposes of verifying my identity and right to work in the UK. These checks can be made for data protection, money laundering, working visa requirements and all other reasonable requests. I similarly authorise Benifacts Umbrella Services Ltd to contact my agency or end user client and authorise them to disclose any information relating to me and my assignment details.

Accept Our Terms & Conditions*

Next steps

Once you select Submit:

  • A copy of the form will be sent to us and
  • We will contact you with your Employment Contract
  • You will need to print the Employment Contract and send it to us with your chosen form of right to work evidence and your passport
  • Full details will be contained in the email

Once we have received these documents we will contact you to arrange a face to face meeting where we will verify your identity and confirm your right to work as per Home Office guidelines.

DO NOT CLOSE THIS WINDOW OR USE YOUR BROWSER BACK/FORWARD BUTTONS UNTIL YOU SEE THE CONFIRMATION MESSAGE

Form complete!

If you have completed the form satisfactorily, please select the 'Submit Registration' button, or click the 'Previous' button to go back and edit your entry (information you have entered will not be lost).

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