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1.0 Introduction
Please complete this application form to register with Stroma Certification to become a registered Legionella practitioner.
Before completing this application form, you must read the Legionella Members Pack. (Download Members Pack).
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Please choose from the following options which best describes your application route:
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2.0 Details of Applicant Applying for Membership
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Are invoices required to be sent to a different address? *
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3.0 Disclosure and Baring Service (DBS)
Applicants wishing to join the Legionella scheme shall provide a basic Disclosure and Baring Service (BDS) certificate that is no more than one year old at the time the application is received. If you are an existing Stroma member, we can accept a DBS dated within the last 3 years.
A copy of the original certificate must be sent with your application. This can be either a clear digital or scanned copy, or a clear photo of each page.
The certificate copy will be retained by Stroma Certification until such a time that either the DEA wishes to leave the scheme, or the certificate is no longer valid. This can be a clear digital or scanned copy, or a clear photo of each page.
If you have an online version that you can 'share with an employer' please email us the link, the last 6 digits of your certificate and the one-time share code so we can view your DBS online.
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4.0 Insurance
Applicants wishing to join a scheme should hold the relevant Professional Indemnity (PI) and Public Liability (PL) Insurance as per the scheme requirements. A clear copy of the original insurance document(s) should be sent with your application to Stroma Certification. This can be a clear digital or scanned copy, or a clear photo of each page.
4.1 Insurance - Per Click
Stroma Certification offer, in partnership with Thomas, Carrol (Brokers) Ltd, a Per-Click policy which you can chose to use, to cover your business for PI and PL under.
Applicants wishing to use the Per Click insurance rather than provide their own cover, shall provide a completed Per Click Proposal Form with your application to Stroma Certification. The Per Click Proposal Form can be downloaded directly:
Legionella Per Click Proposal Form
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Insurance Confirmation *
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4.1.1 Company/Personal Insurance
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Please keep individual uploads less than 1MB per file
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4.1.2 Per Click Insurance
Once you have completed the proposal form (available above), please email it directly to Thomas Carroll Brokers Ltd. Stroma Certification is not able to send this to Thomas Carroll for you due to FCA rules.
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5.0 Identification Checks
You are required to provide a colour copy of either your passport or driving license. Please indicate below which item you will be providing:
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You will be required to provide a colour copy of either your Passport or Driving License. Please indicate which below:
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6.0 Code of Conduct Declaration
To complete your application, you are required to read the Code of Conduct (Provided in the Members Pack Scheme Handbook) then hand sign and return the Code of Conduct Declaration Agreement Form.
We can accept a digital scanned copy, or clear photo of all pages (upload below). Were you are unable to send a digital scan or photo, a paper copy with signature must be posted to the Customer Service Team.
Download a copy of the Code of Conduct Declaration
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Please keep individual uploads less than 1MB per file
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7.0 Training Course / Qualification Certificate
Please upload a colour copy of your training and /or qualification certificate which you currently hold. At present we are able to accept certificates issued from ABBE, City & Guilds and BPEC. Certificates from other sources will also be considered.
This can be a clear digital or scanned copy, or a clear photo of each page.
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8.0 Direct Debit Mandate
You must complete the direct debit mandate and include in your application a hand signed copy of this document. We can accept a digital scanned copy, or clear photo of all pages (upload below). Were you are unable to upload a digital scan or photo, a paper copy with signature must be posted to the Customer Service Team.
Download a copy of the Direct Debit Mandate Form
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Please keep individual uploads less than 1MB per file
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9.0 Declaration
I declare that the all information provided within this document is true to the best of my knowledge.
I confirm that I have read and understood all policies, terms & conditions and relevant documentation provided within the Legionella Members Pack (Download Members Pack) provided on the Stroma Certification’s website. I promise to abide by all rules and ensure that all terms, conditions and standards currently defined within these polices, terms and documentation will be fully adhered to at all times throughout my membership with Stroma Certification.
I agree to declare any County Court Judgements at residential and business trading address upon application of membership - accepting that Stroma Certification may access such evidence independently and that spent County Court Judgement will be at the discretion of Stroma Certification.
I agree to update Stroma Certification with any key changes such as legal status or trading title, trading address, director(s), capability (key personnel, reducing scope of registration) and legal judgements relevant to the scope of registration during my membership.
Stroma Certification will notify the Scheme Member of any changes made. Subsequent changes made to any terms and conditions or supporting policy documentation may require the Scheme Member’s agreement before becoming enforceable. Changes will be communicated to the Scheme Member by Stroma Certification through email. The information on this form supersedes all previous versions.
Stroma Certification will ensure compliance with the General Data Protection Regulation (GDPR) when processing the personal information that you have included within this document. Stroma Certification will only use this information in accordance with the training provider and/ or certification scheme requirements and to contact you about other opportunities with Stroma if you have given permission for this to happen. If you would like to find out more information about Stroma Certification’s compliance with GDPR and your personal data, please visit our website www.stroma.com/data-protection. If you have any questions concerning data protection or the use of your personal data, please contact us before submitting this document.
I confirm acceptance of all terms and conditions relating to the certification scheme as the Key Representative of the Organisation. All relevant staff shall, at all times, comply fully with the requirements for the relevant scheme Code of Conduct. Furthermore, I confirm that by signing below, I hereby agree that details of our Organisation may be published on the TrustMark website as part of our on-going certification.
Stroma Certification reserves the right to charge Organisations an administration fee of £25.00 +VAT for a cancelled application.
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Please tick to confirm *
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Produced By: Steven Marriott
Authorised By: Sam Cantle
On behalf of Stroma Certification Ltd
Issued Date: 22/07/2021
Issue Revision: v1.2
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