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Empowering working people Creating better communities


Member Service Centre 0800 389 6332

servicecentre@community-tu.org @CommunityUnion facebook.com/CommunityUnion

www.community-tu.org

The Direct Debit Guarantee This Guarantee should be detached and retained by the payer ● This guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. ● If there are any changes to the amount, date or frequency of your Direct Debit, Community will notify you ten working days in advance of your account being debited or as otherwise agreed. If you request Community to collect a payment, confirmation of the amount and date will be given to you at the time of the request. ● If an error is made in the payment of your Direct Debit, by Community or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. ● If you receive a refund you are not entitled to, you must pay it back when Community asks you to. ● You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.


APPLICATION FOR MEMBERSHIP □ Male □ Female

ABOUT YOU …

□ Mr □ Ms □ Mrs □ Miss

Forename . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Surname. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . National Insurance No. (Optional) . . . . . . . . . . . . . . . . . . . . . . . . . . Date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City/town . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . . . . . . Home Tel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mobile

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Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Detach completed form — moisten glue and seal — no stamp necessary

Have you previously been a member of Community? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ABOUT YOUR JOB … Employer/Company Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Work address

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Postcode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Work Tel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Average weekly wage including overtime (before tax) £ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occupation

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Shift

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Payroll no.

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Have you recently been a member of any other union? (Please specify) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tick one box only

□ I am a full-time employee □ I am a part-time employee □ I am an apprentice □ I am a student in full-time education □ I am self-employed □ I am not employed

DECLARATION I understand that once accepted into membership of Community I become subject to the rules and policy of the union and to the decisions of its national executive council Applicant’s signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DATA PROTECTION NOTICE Community is a data controller, and processes information (data) which you give us on this application form and subsequently. Your information is used for the effective operation of the trade union and to provide you with the right to vote and to receive union goods, benefits and services. Community does not share your information with any other data controllers, but may contract approved data processors to deliver goods, benefits and services to union members. We may share your information with organisations with which we work in partnership. We or they may contact you by mail, telephone, SMS, fax or email, to let you know about goods, services or promotions that may interest you. You have a right to ask for a copy of your information (for which we charge a small fee) and to correct any inaccuracies. To make sure we maintain our standards of service we may monitor or record communications. You understand that by making this application for membership you consent to Community’s processing of data supplied by you,including sensitive personal data, for the purposes stated above.

EQUALITY MONITORING Community is committed to the promotion of equal opportunities for all and it is the union’s aim to provide services and support to members that is free from discrimination on the basis of race, gender, religion, sexual orientation or disability. What ethnic group do you belong to? □ White British □ Mixed other □ Asian or Asian British other □ Mixed White & Asian □ White Irish □ Asian or Asian British Indian □ Black or Black British Caribbean □ Other, please specify □ White other □ Asian or Asian British Pakistani □ Black or Black British African . . . . . . . . . . . . . . . . . . □ Mixed White & Black Caribbean □ Asian or Asian British □ Black or Black British other Bangladeshi □ Mixed White & Black African □ Chinese □ Do you regard yourself as having a disability?

For union use only Date of entry Branch or workplace name

Membership No. BR.IND

Grade


Instruction to your bank or building society to pay by Direct Debit Please fill in the whole form, including the official use box, with a ballpoint pen using BLOCK CAPITALS and send it to:

Community, 67/68 Long Acre, Covent Garden London WC2E 9FA Name and full postal address of your bank or building society To: The Manager

Bank/building society

Service user number 7

5

3

3

2

8

For Community official use only This is not part of the instructions to your bank or building society Account holder’s address (if different from member’s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address .

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Postcode.

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Tick the day of the month on which you would prefer your account to be debited

□ 25th

Name (s) of account holder(s)

□ 1st

Reference (Office use only)

Bank/building society account number

Branch sort code

Instruction to your bank or building society Please pay Community Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit guarantee. I understand that this instruction may remain with Community and, if so, details will be passed electronically to my bank/building society. Signature(s)

Date

Banks and Building Societies may not accept Direct Debit instructions for some types of account.


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Freepost Plus RRYB-SSYK-AXEB Community Member Service Centre Carpet Weavers Hall Callows Lane KIDDERMINSTER DY10 2JG


New membership form 2013