Supply Type

IMPORTANT : Please note that it is essential that this form is completed correctly. Please have your UTR and/or company registration number to hand in order to complete the form. One Supply Type form must include all methods you work through with your relevant UTR and/or company registration number(s) when working via multiple methods. Should information be missing you will need to complete the form again. Many thanks for your understanding and support. *

I confirm that I have read and understood the above

* Indicates required field

First name *

Surname *

GMC number *

Please select ALL that apply: *

1. Self-Employed contractor, like a sole trader 2. Sole employed contractor from a partnership 3. Sole employed contractor from a limited liability partnership 4. Worker from a limited company including personal service companies

If you HAVE selected options 1, 2, or 3, please enter your Unique Taxpayer Reference (if you have NOT selected options 1, 2, or 3, please enter 'N/A') *

If you HAVE selected option 4, please enter your company's registration number (if you have NOT selected option 4, please enter 'N/A') *

Terms & conditions

I declare that all information given, as well as any documentation provided, is accurate. I agree that if I have given any false information or have refused to submit any relevant information, this may lead to the application being declined or instant dismissal from any assignment. I understand that it is solely my responsibility to update locum.co.uk with any changes in how I supply my services. I declare that I have received and read the terms and conditions and accept the applicable terms of engagement. I acknowledge that my personal details will be stored and handled correctly by locum.co.uk in accordance with General Data Protection Regulations. I agree that my personal details, including all documentation, may be made available for audit by customers and clients of locum.co.uk and their appointed auditors. *

I confirm that I have read and agree to the above declaration

Submit