MEMBERSHIPAPPLICATION FORMJoin Britain’sBIGGESTunionwith over 1.5 million people just like you

JOIN TODAYsimply complete this form or visitwww.unitetheunion.org

IT’S VERY EASYTO BECOME A MEMBERvisitwww.unitetheunion.orgor complete this form following these simple steps

1 Start by filling in details about youPlease be as accurate as possible, so that we can contact you. If you have anemail address, please tell us. Completionof your ethnic origin helps us to directservices for the benefit of members.

2 Tick your membership rate and whetheryou are full or part-time If you are a driver and wish to join theDriver Care scheme, please tick theappropriate box to receive a separateapplication form for this service.

3 Employer’s detailsIncluding the postcode where you workhelps us identify members and officialsnear you, should you need support.Additional information, such as yourNational Insurance number, assist us in dealing with any claims or issues.

4 Choose how to payEither through check-off, your wages, or direct debit from your bank/building society.

5 Direct Debit detailsIf you have chosen this method.

6 Previous union membership

7 Sign and dateThen hand in the form to your Uniterepresentative or return by post to your regional office.

Unite Legal and Affiliated BenefitsAs a member of Unite you have access to a range of specially negotiated benefitsand services. Please tick the box below if you would like more information on:

Unite Legal Services Unite Life InsuranceUnite MortgagesUnite Prepaid Debit CardUnite Home InsuranceUnite Motor InsuranceUnite LotteryUnite PPI Reclaims Unite Personal Financial Review

Insurance RenewalsPlease tell us in which month your keyinsurance policies are due for renewal so that we can send you details ofspecial Unite deals:

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Motor

MEMBERSHIP FORMGB About You

About Your JobInstruction to your Bank or Building SocietyPlease pay Unite the union Direct Debit monthly from the account detailed in this instruction subject to thesafeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Unitethe union and, if so, details will be passed electronically to my Bank Building Society.

Sort Code

Name of bank/building society

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–

–

–

/ /

Account Number

On the selected day of the month:

Originators ID Number 9 7 1 4 6 7

14th 21st

Name(s) ofAccount Holder(s)

7th 28th

Surname

Forename

NI No.

House No./Name

Street

City/Town

Home Tel.

Employer /Company Name

Job Title

Work Address

Postcode Work Tel.

Email

Date of Birth

MrMsDrMale Female

Postcode

Mobile

MrsMissRev

On certified apprenticeship schemeYear 1 Year 2 Year 3 Year 4

Please tick if you wish to receive the union’s magazine

Which membership do you require?

Other (eg Unemployed member of the community, working less than 10 hoursper week, under 18, full time student, retired, permanently disabled)

TEAR OFF COMPLETED FORM

– MOISTEN GLUE AND SEAL – NO STAMP NECESSARY

Authorisation of deduction of your trade union contribution from your pay (check-off)

Note: Not all employers operate check-off. I hereby authorise the deduction of Unite the unionsubscriptions from my pay of such amounts as shall be notified to my employer on my behalf from time to timeby Unite the union. I also authorise my employer to inform Unite the union of any changes of address.

Payroll No.Paid weekly or monthly? MonthlyWeekly

Equal Opportunities

Unite the union is committed to the promotion of equal opportunities for all and it is the union’s aim to provide servicesand support to members that is free of discrimination on the basis of race, gender, religion, sexual orientation or disability.What ethnic group do you belong to?

White BritishWhite IrishWhite Other

Mixed White & Black CaribbeanMixed White & Black AfricanMixed OtherAsian or Asian British Indian

Asian or Asian British PakistaniAsian or Asian British BangladeshiAsian or Asian British Other

Black or Black British African

ChineseMixed White & Asian

Other/please specify

Please tick if you regard yourself as disabled Please tick if you are Lesbian Gay Bisexual Trans

Black or Black British Other

Black or Black British Caribbean

Town of the Bank

Are you or have you been a member of a trade union? (including Unite the union)If yes, please give the name of the union and date of last payment

When you join Unite, you are also authorising the Union to deduct an additional amount for your subscriptionto your local branch fund.I agree to abide by the union’s rules. I authorise the payment above:

Please read the Data Protection Notice.You have the right at any time to stop us using your details for third party marketing purposes. If youdo not wish us to communicate with you or share your contact data for these purposes, please tick this box. Please note that this will preclude you from receiving our special offers or promotions.

/ /Signature Date

RecruitmentCode

JobCode

Yes No

Branch No.HEmployer

CodeWorkplace

Code

For Office use only

UNITE THE UNIONBACKING YOU ALL THE WAY

IT MAKES SENSE to have someone on your side. We want to help you get stronger at work. Only a

union with the massive financial, legal and industrial back-up of Unite can provide the representation and influence in the workplace that you need.

OUR AIM is to get you the best terms and conditions ofservice and provide the advice and support, on any matter,

you may need related to your job. For more information contact your regional office. Contact details for each

office can be found at www.unitetheunion.org

Direct Debit Details – Instructions to your Bank or Building Society to pay by Direct Debit

Core full time (21 or more hours per week) Core and Ancillary full time (21 or more hours per week)Core part time (10 or more but less than 21 hours per week) Core and Ancillary part time (10 or more but less than 21 hours per week)

Membership No.

Driver Care (a separate Driver Care application form will be sent to you for completion)

DIRECT DEBIT GUARANTEEThis Guarantee is offered by allbanks and building societies thataccept instructions to pay DirectDebits. If there are any changes tothe amount, date or frequency ofyour Direct Debit Unite the unionwill notify you ten working days in advance of your account beingdebited or as otherwise agreed. Ifyou request Unite the union tocollect a payment, confirmation ofthe amount and date will be givento you at the time of the request. Ifan error is made in the payment ofyour Direct Debit, by Unite theunion or your bank or buildingsociety, you are entitled to a full andimmediate refund of the amountpaid from your bank or buildingsociety. If you receive a refund youare not entitled to, you must pay it

back when Unite the union asks youto. You can cancel a Direct Debit atany time by simply contacting yourbank or building society. Writtenconfirmation may be required.Please also notify Unite the union.

DATA PROTECTION NOTICEBy joining Unite the union you are providing information whichmay be used for administrativepurposes, the holding of electionsand other statutory requirements.If you do not tick the box at mark ‘Data Protection Notice’you consent to Unite the unionpassing on your information forthe promotion of membershipservices (e.g. insurance). We maydisclose your information to ourservice providers and agents forthese purposes. However, if we

do disclose your information, we will put a contract in place toensure it is protected.We or they may may contact youby post, telephone, e-mail, text orsuch other means as we mayagree with you from time totime, to let you know about anygoods, services or promotionsthat may be of interest to you.We may keep your informationfor a reasonable period to contactyou about our services.You have the right to ask for a copy of your information (for whichwe charge a small fee) and tocorrect any inaccuracies. To makesure we follow your instructionscorrectly and to improve ourservice to you through training ourstaff, we may monitor or recordcommunications.

Please tick