Tel: 0845 805 0501

APPLICATION FORM
PRIVATE & CONFIDENTIAL

Please print in CAPITAL LETTERS. You must complete all parts and return to 1 Mount Pleasant, Douglas, IM1 2PU.

PERSONAL INFORMATION

Address
If you have lived at
this address for less
than 3 months
please also provide
your previous
address below

Former Surname
(if applicable)

Town / City

Date of Birth

County

NI Number

Postcode

Nationality

Previous Address

Home Telephone

Mobile Number

Personal Email

Job Title

Occupation

Industry

Title

First Name

Middle name

Surname

Are you registered

for Self-Assessment
(SA)?

Yes

No

If Yes, please provide SA

registration number or Unique
Tax Reference number

Are you registered

as Self-Employed? *

Yes

No

If Yes, please provide Unique

Tax Reference number

* By completing and returning this application, you consent to PCL registering you for Self-Employment on your behalf, if not already registered.

BANKING INFORMATION
DETAILS
Bank Name

Account Number

Account Holders Name

Sort Code

Building Society Ref

Account Currency

Sterling

Euro

Dollar

INVOICING INFORMATION
Recruitment Company/
Client Name

Contact Telephone
Number

Contact Name

Contact Email Address

Recruitment Company/
Client Address

Are you paid

Weekly

Proposed start date

Your Pay Rate

Daily Amount

Weekly Amount

Monthly

HOW DID YOU HEAR ABOUT US?

Friend

Name of Friend

Agency

Accountant

Website

Other

KNOW YOUR CUSTOMER INFORMATION

For your security and protection, PCL uses an electronic identity and address verification. As part of this compliance procedure, PCL will
require you to provide a minimum of 2 documents, as detailed below.

DATA PROTECTION NOTICE

PROOF OF IDENTIFICATION
PASSPORT
Please provide a clear copy of your passport, which must be in date and not due to expire within 3 months.
In certain circumstances additional certification may be required.
OR
DRIVING LICENCE
Please provide a full copy of your full driving licence (card and paper part) which must be in date
and not due to expire within the next 3 months. In certain circumstances additional certification may
be required.
PROOF OF ADDRESS
UTILITY BILL OR BANK STATEMENT
Please provide a clear copy of a recent utility bill orDECLARATION
bank statement (dated within the past 6 months).
In certain circumstances additional certification may be required.
NB. For ID verification, please provide a scanned copy of your passport or both parts of your driving licence, along with your completed
application form. The following documents are not acceptable - Mobile Phone Bill, Tenancy Agreement, Online Bank Statement. A driving
licence cannot be used for proof of address and identification.

IMPORTANT
Incomplete applications will cause delays with any payments so please take time to review the requirements carefully. If you have any
questions please call 0845 805 0501 for assistance.

FOR PCL USE ONLY

App Received date
Contractor Number

Live on Payroll Date