yourHealth Cash Plan

Registration Form
To register for yourHealth Cash Plan, please complete the details below :

Covering yourself
Employee number:

Title: (Mr/ Mrs / Miss etc)

First Name:

Surname:

This registration form will be processed and sent to Bupa. We will provide Bupa with details of your
address. This will be taken from Workday, so please ensure this is up to date with your current
address details.

Bupa will send you a Welcome Guide confirming your cover.

The Welcome Guide will include information on what you need to do if you wish to add children, at no
additional cost, to your policy. It will also contain details about how, if you wish, to upgrade your cover
and benefit levels.

We are committed to protecting and respecting your privacy. We will not share information about you
with third parties without your consent unless the law allows or requires us to. Your enrolment in this
benefits is by your consent only. You will be able to withdraw consent at any point raising a ticket via
Workday Help.

Signing your Registration form. By signing and returning this form I am aware that:

 I am agreeing to my home address, date of birth and the personal information above being
passed to the Cash Plan provider.
 yourHealth Cash Plan is a taxable benefit. As a result, Southern Water will report this to the
Inland Revenue and my tax code will be adjusted accordingly.

Signed :

Name :

Date :

Returning your Registration form

Please sign and submit your Registration form to the People Hub Team via Workday Help
ticketing system.

Please note : Registration forms returned by 25th of the month will be processed for your cover to
start from the first day of the following month.

11/01/2023 Cash Plan Registration Form