Sign Up

Please complete the form to enrol with our services.

Product Selected
Your Personal Details
Your Title*
Prefix
Your Name*
First Last
As you would provide on official documents
Your Home Address*
Street Address Address Line 2 City Post Code Country
Your Contact Telephone Number*
Your primary personal contact number
Email*
Enter Email Confirm Email
Date of Birth*
Your Role / Job Title
Please enter your primary occupation
Your National Insurance Number
We understand if you are unable to provide your National Insurance number right now, but we will need this to complete your application so providing it will ensure faster processing.
Your Nationality*
If your nationality is not listed, please select 'Other'.
Other Nationality*
Photographic ID
Accepted file types: jpg, pdf, png.
MUST BE YOUR PASSPORT or DRIVERS LICENCE. To process you application we can accept a photograph of your ID taken with a smartphone etc, please ensure photo is clear and legible.
Proof of Address
Accepted file types: jpg, png, pdf.
UTILITY BILL or BANK STATEMENT dated within the last three months, driving license cannot be used as proof of address. To process you application we can accept a photograph of your proof of address taken with a smartphone etc, please ensure photo is clear and legible.
Do You Require a Work Permit?
- Yes
- No
Your P45 and Tax Status
- This is my first job since 6th April and I have not been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance or taxable Incapacity Benefit or a state or occupational pension.
- This is now my only job, but since last 6th April I have had another job, or have been receiving taxable Jobseeker’s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a state or occupational pension.
- I have another job or receive a state or occupational pension.
- I will attach a copy of my P45 or send via email
Upload P45
To process you application will accept a photograph of your P45 taken with a smartphone etc, make sure photo is clear and legible.
Your Rate of Pay*
per*
Average Hours / Days per week.*
How many days / hours do you work on a weekly basis?
Your Bank Details
Bank details are needed to complete your application.
Bank Name
Bank Account No
Enter your 8 digit UK Bank Account Number here (numbers only field.)
Building Society Ref if Applicable
Account Holder Name
Bank Sort code
Please enter your 6 digit Bank Sort Code (Numbers only.)
Your Agency Details
Agency Name*
Your Contract: Agency Name (if applicable.)
Agency Contact Name
First Last
Your Agency Email

Ideally the email of your consultant or a general email.
Your Agency Address
Street Address Address Line 2 City Post Code Country
Agency Website

If you know it.
Declarations
*
- I confirm that all the information supplied on this form is true and accurate to the best of my knowledge up to and including the completion date of this form.
*
- I willingly consent to my personal details being held in both electronic and paper format (in accordance with the Data Protection Act 2002) and where necessary shared with carefully selected third parties for the purposes of providing me with the best possible service at all times.
*
- I hereby give my consent for all funds to be sent to the bank account noted above, if I am not the owner of this account then the account holder must also sign below to indicate their consent for funds to be sent to their account. Alpha Republic cannot be held responsible/liable for any breakdown in communication between you and the account holder once this form has been signed by both parties.

Sign Up

Your Personal Details

Your Bank Details

Your Agency Details

Declarations

Useful Links

Alpha Republic

Hours of Business