Personal Application Form

Status - SSAS Member Trustee or SSAS Member Only

Full Name inc. middle names (required)

Home Address (required)

Postcode

National Insurance No (required)

Date of Birth (required)

Telephone No. (required)

Email Address

Occupation

Main Employer’s Name and Address (Trading Co)

Marital Status, please tick:

MarriedCivil PartnershipLiving with Partner DivorcedSeparatedSingleWidowedEngaged

Spouse Name inc, Middle Names:

Spouse Date of Birth

Directorships (Company Name) & Date Appointed

Shareholdings (Company Name) & Shareholding %