iBalance - The Umbrella Option
The Umbrella Option 


iBalance Registration Form


All highlighted fields are mandatory.

Personal Details
Title
Full Name
Sex
Preferred Name
Postcode    
 
Address
City
Telephone or
Mobile
Fax
Email
National Insurance Number
Date of Birth
Passport Held
Occupation / Job Title
Work Sector
Your Agency / Client
Agency Name
Contact Name
Contact Telephone
Postcode    
 
Address
Telephone
Fax
Email
The Contract
Client Company Name   * optional
Site Address * optional
Country where work is based
Start Date
End Date

Rates
Standard Rate A Rate B Rate C
Rate Type
Currency
Timesheet Intervals
Bank Account Details

This this the account which you would like your net payments transferred into.

Sort Code
Account Number
Account Name
Account Reference
Other Details
How did you hear about us?
Other Referral Method
Name of Referrer
Any Other Notes
Insurance Declaration
I declare that after enquiry,
  • I have had no Professional Indemnity claims made against me
  • I have not received any notification of a possible Professional Indemnity claim against me
  • I are not aware of any situation which may give rise to a Professional Indemnity claim against me

  
  
(Please Click Agreed or Not Agreed)