Subcontractor Details – Titan Drylining Forms Portal

Contact Details

Region*

Full name OR your company name*

Your Address

Street Address Address Line 2 Town County Postcode

Home Number

Mobile Number*

Email*

Personal Details

N.I Number OR Company Reg No.*

U.T.R Number*

Bank Account Number*

Bank Sort Code*

CSCS CARD (attach copy)

Max. file size: 2 MB.

Trades*

Health Details

Your Date of Birth*

Emergency Contact - Name*

Emergency Contact - Phone Number*

Do you experience any of the following symptoms? Please type 'yes' or 'no'. If 'Yes' please give details.

Coughing, wheezing, breathing difficulties, Asthma, Bronchitis, tuberculosis or any other chest disease?*

Itching, redness, excessive dryness, or blistering of skin?*

Ongoing pain, such as: back, hand, wrist, fingers, neck etc?*

Any health conditions that may need additional consideration for working on a construction site (e.g. heart conditions, epilepsy)?*

Have you been to the doctor in the last year due to any of the above or anything that may be work related?*

GDPR - Data Protection*

Opt-In

Please tick this box to give your consent for Titan Drylining to securely store this information for the following use: - Contact you to offer and arrange work - Make payments into your bank account - Pay over CIS deductions - Contact your Next-of-kin in the event of an accident. - Health surveillance (required by law) - Book training courses if required (Titan's Data Protection policy can be found on our website).

Please complete the following to confirm that the details entered above are correct.

Signed*

Dated*

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