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Email Address:

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My profession is: (please select from the list below)

You are entitled to claim if you have to wear a uniform and launder it yourself.

Do you wish to claim for this expense? No Yes

Purchase of shoes and tights/socks

You are entitled to claim if you provide direct patient care.

Do you wish to claim for this expense? No Yes

Professional Fees

You are entitled to claim if you pay professional fees (eg UNISON, RCN, HCPC).

Do you wish to claim? No Yes

Other Professional Associations

You are entitled to claim for other professional associations (eg Society of Radiographers).

Do you wish to claim? No Yes

National Insurance Number:

Have you been required to submit a Self-Assessment tax return in the last four years?

Have you changed your name within the last year, or do you use a professional name?

No Yes

Would you like your rebate cheque payable to a name other than shown above?

Have you changed your address within the last year?

No Yes

Have you changed school within the last year?

No Yes

Have you applied for a tax rebate within the last 12 months?

Your Workplace Email Address:

How did you hear about SRS Healthworkers?

M&S Gift Card Promotional Code:

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Subscriptions Rebate Services Limited

E: info@srs-healthworkers.co.uk
T: 0161 370 6555

Registered in England and Wales: 06914729
VAT Registration Number: 122983019
Registered Address: Centurion House, 62 Seymour Road South, Clayton, Manchester, M11 4PR

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