Application for the Site Manager Accreditation Programme

Application for the Site ManagerAccreditation ProgrammeNHBC USE ONLYCandidate reg no.Complete electronically and print. Please use BLOCK CAPITALS if completing this formby hand. Please obtain signatures and post to: Training Services, NHBC, NHBC House,Davy Avenue, Knowlhill, Milton Keynes MK5 8FP.Please note:To be able to apply for this programmeyou will need an email address andinternet access.Applicant detailsTitle:Last name:Date of birth:Address:First name(s):Postcode:Telephone:Email address:National Insurance number:Mobile:Only site managers who hold a Black orPlatinum (manager) CSCS card areeligible to apply.Black or Platinum CSCS card number:Job title:Site name:Site address:Please tick one box only.I confirm that I am the site manager running the above siteI confirm that I am a site manager running a discrete part of the large project on the above siteNHBC Building Inspector's name (for above site):ooApplications will only be accepted withboth applicant and company signatures.Applicant signature:Date:Please note:This should be the person who isauthorising this application and willbe used by us for all correspondenceto the company.Company detailsCompany name:Company address:NHBC registration number (if applicable):Contact information:Title:Last name:Job title:Telephone:Email address:Company signature:This signature confirmsacceptance of the termsand conditions.First name(s):Date:

Payment detailsApplicant’semployerApplicant’s site(at the time of initialaccreditation or renewal)Initial accreditationAnnualrenewalTickNHBCregisteredbuilderRegistered withNHBC for warrantyNot registered withNHBC for warrantyFREE for the first 1000 applicationsreceived £45 thereafter£150 if application received as partof the first 1000 £195 otherwise£45 o£195 oOtheremployeror selfemployedRegistered withNHBC for warrantyNot registered withNHBC for warranty£95 £95 o£245 £245 oPayment methodPlease invoice me (NHBC registered builders or account holders only)Tick one boxoPurchase order number if using a procurement system:I enclose a cheque for the fee +VAT made payable to NHBCPlease debit my VISA/MasterCard (delete as applicable) for the fee +VATooCard number:Valid from:Cardholder's name: (please print)Cardholder's signature:/ Expiry date: /Date:Terms and conditions1. The fee is non refundable.2. Programme fees should accompany this application form unless requesting an invoice, onlyavailable if you are an NHBC registered builder or an NHBC account holder.Data ProtectionDetails you have provided will be entered onto our database, which is registered under the Data Protection Act.Data Protection Act 1998 (This notice only applies to individuals and not to limited companies).NHBC is the data controller. We store the details you supply for administration purposes and sales analysis.By completing and returning this form you agree to NHBC processing your data. If you do not wish to be approached,please tick the appropriate box(es).In the future, we may contact you for research purposes or to keep you informed of NHBC products and services thatmay be of interest to you.If you do not wish to be contacted by NHBC, please tick the box oNHBC may also pass your details to carefully selected third parties who may contact you with free publications andselected offers that they believe may be of interest to you.If you do not wish your details to be passed on to third parties, please tick the boxoThere is a government initiative to provide Unique Learner Numbers. If you do not wish us to apply for this on your behalf,please tick the box. We do have to offer you this option, however, if this box is ticked we will not be able to register you forthis programme oNHBCNHBC House, Davy Avenue, Knowlhill, Milton Keynes, Bucks MK5 8FPTel: 0844 633 1000 Fax: 0844 633 0022 www.nhbc.co.ukE134 07/11