BOTTOM OF THE HARBOUR
Application
Title *
 Mr 
 Mrs 
 Ms 
 Miss 
Name *

First
Last
Current Address if less than 3 years Please provide date moved in Below. *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Not PO Box
Date Moved into current address if less than 3 years
Primary Contact Number *
Email *
Date of Birth Day Month Year *

DD		/
MM		/
YYYY
Nationality *
National insurance Number
It is Compulsory to have a National Insurance Number, please find below the number to call to arrange this ASAP.
Once you receive this please email us immediately with the information.
0845 600 0643
You will be given a temporary Insurance National Number until you provide us with one. it is a legal requirement to work in the UK!
Expected Exit from the UK if Applicable

DD		/
MM		/
YYYY
Previous Address from 3 years ago

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Previous Employment
Profession *
Do you have professional Indemnity Insurance? *
 Yes 
 No 
if No, would you like us to oragnise professional indemnity Insurance for you? (approx.£10 to 20 a week depending on occupation) Jo will give you a call to go through this with you.
Hourly Rate of Pay
Input hourly wage, if not salaried.
Current place of employment
Agency and consultant name
Agency Phone Number
Agency Email
Agency Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Date work commenced

DD		/
MM		/
YYYY
Please let us know if you know when you will be starting work or are already currently in a locum position
Who referred us to you
Your new Company Name
Enter 3 suggested names for your company. They should not be a common name, it has to be a company name that is not used in the uk. Try and think of something where you lived etc...
If you would like us to choose please let us know *
Name of Bank
Personal Bank Sort code
Personal Bank Account Number
Place of Birth (As on Passport) *
Mother Maiden Name *
Eye Colour *
Father Name *
Upload a File
We need to set up your companies bank account and there will be a credit check.
Please send us a copy of your Passport & work visa and your proof of your ID. We also need proof of AV, a UK or Australian bank statement (all pages). These must be of a good quality. If you can not upload file, please email Docs to david.both@me.com
Information
Once this has been submitted we will contact you about coming in to open up your company bank account. We would also like your contact address from your previous country if you intend on returning back at a later date for correspondence.
Please note you need to fill in the image verification for security reasons before sending the form.
Image Verification
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www.bottomoftheharbour.co.uk
Level 17 Dashwood House, 69 Old Broad Street, London, EC2M 1QS
Level 57, MLC Centre, 19 -29 Martin Place, Sydney 2000
Bottom of the Harbour Limited is a company registered in England & Wales, Company No: 6220740
both@me.com Mob: +44 (0)7 918 734 330 Ph: +44 (0)20 7256 4257 Fax: +44 020 7256 4157
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