Employer Registration Please complete the form below to register as an Employer. YOUR DETAILS First Name * Surname * Email * Job Title COMPANY DETAILS Company Name * Company Address Company Postcode Telephone Company Reg. No. PAYE Ref. No. No. Employees No. of Sites Payroll Run Date Pay Date Payroll Email Purchase Ledger Email Invoice Payment Method Direct Debit BACS SERVICES REQUIRED Schemes / Services required Company Paid Assist Protect Employee Assistance Employee Rewards Flu Vaccinations Gym & Fitness Health Cash Plans Life Insurance Medical Insurance Occupational Health Retail Discounts Salary Sacrifice Cycle to Work Holiday Exchange Childcare Vouchers Car Scheme Health Screening Save As You Learn Voluntary Utility Discounts Will Writing Cycle Insurance Cyclist Protection Payroll Giving Preferred Contact Method? Phone Email Fax Post Face to Face (by appointment) How did you hear about us? Search Engine Website Press / Advert Exhibition Accountant Payroll company Word of Mouth Other YOUR AGREEMENT * I confirm that I give Gemelli permission to contact me in relation to this enquiry using the details provided. DATA PROTECTION The information that you provide on this form will be used in a confidential manner to help us process your request. We abide by the Data Protection Act and General Data Protection Regulations. We are conscious of only taking the personal data from you that we require and will keep it safe and secure. Please confirm you understand and agree to this Data Protection Statement and that we need to take details about you to process this application. You can find details of how we process your personal data in our Privacy Policy on our website. * I confirm I understand and agree with this Data Protection Statement. SUBMIT YOUR REGISTRATION Please now submit your registration by clicking on the button below. One of our team will be in touch shortly – thank you. reCAPTCHA If you are human, leave this field blank. Submit
