Supply Type

* Indicates required field

First name *

Surname *

GMC number *

Please select as many as 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 selected options 1, 2, or 3, please enter your Unique Taxpayer Reference *

If you selected option 4, please enter your company's registration number *

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