Title
First Name
Last Name
Contact number
Preferred Contact Time
I am permanently resident and working in the UK, Channel Islands or the Isle of Man
I have been in permanent employment/contract employment or in self employment for more than 16 hours per week for at least the last 12 months
I can confirm that I have not been registered as unemployed at anytime in the last 24 months
I can confirm that I am not aware of any possible redundancies, restructure, reorganisation, financial or contractual threats to my job role within the business I work
I understand that I will not be covered for any pre-existing medical condition that I may have. A condition is considered as pre-existing if it is a condition that I have received treatment for, knew about or ought reasonably to have known about during the last 12 months