Medical Payroll Registration (Ltd Company) Director and Company Information Title: Mr. Mrs. Miss. Ms. Dr. First Name: Middle Name(s): Last Name: Company Name: Company House Registration Number: Company Address Premisis Number/Name: Address Line 1: Address Line 2: Town/City: County: --Please Select-- Avon Bedfordshire Berkshire Bristol Buckinghamshire Cambridgeshire Cheshire Cleveland Cornwall Cumbria Derbyshire Devon Dorset Durham East Riding of Yorkshire East Sussex Essex Gloucestershire Greater Manchester Hampshire Herefordshire Hertfordshire Humberside Isle of Wight Isles of Scilly Kent Lancashire Leicestershire Lincolnshire London Merseyside Middlesex Norfolk North Yorkshire Northamptonshire Northumberland Nottinghamshire Oxfordshire Rutland Shropshire Somerset South Yorkshire Staffordshire Suffolk Surrey Tyne and Wear Warwickshire West Midlands West Sussex West Yorkshire Wiltshire Worcestershire --UK Offshore-- Channel Islands Isle of Man --Northern Ireland-- Antrim Armagh Down Fermanagh Londonderry Tyrone --Scotland-- Aberdeen City Aberdeenshire Angus Argyll and Bute Borders Clackmannan Dumfries and Galloway Dundee (City of) East Ayrshire East Dunbartonshire East Lothian East Renfrewshire Edinburgh (City of) Falkirk Fife Glasgow (City of) Highland Inverclyde Midlothian Moray North Ayrshire North Lanarkshire Orkney Perthshire and Kinross Renfrewshire Shetland South Ayrshire South Lanarkshire Stirling West Dunbartonshire West Lothian Western Isles --Wales-- Blaenau Gwent Bridgend Caerphilly Cardiff Carmarthenshire Ceredigion Conwy Denbighshire Flintshire Gwynedd Isle of Anglesey Merthyr Tydfil Monmouthshire Neath Port Talbot Newport Pembrokeshire Powys Rhondda Cynon Taff Swansea Torfaen The Vale of Glamorgan Wrexham Postcode: Contact Details Telephone Number: Email Address: Date of Birth: Company UTR Number: Company VAT Number: Company Bank Details Account Name: Bank Name: Sort Code: Account Number: Building Society Reference: Proof of ID Please upload the following: Company Liability Insurance, Passport (and VISA/BRP if required), Company VAT Certificate (if VAT registered). Maximum Total File Size: 50MB Work Information Job Title: Agency/Client Name (company requiring your services): Contacts Name: Contacts Telephone Number: Data Privacy By ticking the below box you agree to our GDPR Privacy Policy I agree:
