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OCCUPATION DETAILS |
Self Spouse/Partner
Occupation/Profession ______________________ _______________________
Status Self Employed q Self Employed q
Employee q Employee q
Company Director q Company Director q
Not in employment q Not in employment q
If you are a company director,
do you together with associates
own more than 20% of the
company’s shares? Yes q No q Yes q No q
If you are self employed, when
did self employment commence? _____________________ _____________________
Business/Employer’s address ______________________ _____________________
______________________ _____________________
______________________ _____________________
Length of time with current
Employer _____ Year _____Months ______Year _____Months
Previous self employment/
employment, over the last
7 years:
Please give details ______________________ ______________________
______________________ ______________________
______________________ ______________________
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EMPLOYEE BENEFITS |
Self Spouse/Partner
Are you a member of a company?
pension scheme or group personal
pension scheme?
(Please give details in pension
scheme arrangements section) Yes q No q Yes q No q
Does your employer offer a pension
arrangement which you have not
joined? Yes q No q Yes q No q
If yes, please give details _________________ _______________
Is life cover/dependents’ benefits
provided? Yes q No q Yes q No q
If yes, how much? _________________ _______________
Is medical insurance cover
(e.g. BUPA) provided? Yes q No q Yes q No q
If yes, please give details _________________ _______________
Is income replacement insurance
cover provided whilst ill? Yes q No q Yes q No q
If yes, please give details _________________ _______________
Does your employer offer any share
incentive schemes or share option
schemes which are open to you? Yes q No q Yes q No q
If yes, please give details _________________ _______________
Are you provided with any other
benefits in kind? Yes q No q Yes q No q
If yes, please give details _________________ _______________
_________________ _______________
Please supply a copy of current Employee Benefits Handbook if appropriate.