PLEASE PRINT DETAILS CLEARLY

Fees and Expenses for Casual Workers

Department/Unit

Bank Details
Bank Name Sort Code:...(6 Digits) Account Number: ...(8 Digits) Roll A C Number (Building Societ! Acc "nl!)

Surname

Forenames

...

itle Mr/Miss/Ms/Mrs/Dr/!rof (Circle as appropriate) "ther please state#########$$$$$$$$$$$$$$$$$

Date of Birth (Mandatory) %ational &nsuran'e %um(er

If claimant does not have one or begins with TN then leave blank.

)ddress for !ayslip .. .. !ost Code.. .. #nternal Address $%ternal Address &ick bo% as a''ro'riate

*ome )ddress if different from a(o+e .!ost Code..

elephone %um(er , Work undertaken and dates -orked / / to / /

Si.nature,

Date,

PLEASE PRINT DETAILS CLEARLY

STAFF EQUAL OPPORTUNITIES CLASSIFICATION FORM Surname: Date of Birth: Department: First Name(s):

University College London has a commitment to ensuring that staff are appointed and promoted on the asis of merit! regardless of ethnic origin! se" or disa ility! se"ual orientation! race! colour! nationality (#ithin current legislation)! marital status! caring or parental responsi ilities! age! or eliefs on matters such as religion and politics$ %onitoring ena les us to see #hat is happening in practice! to assess the impact of our e&ual opportunities policy and its implementation! and to set any targets for improvements! and measure progress$ 'o ena le us to do this! and to ma(e the e"ercise successful! #e rely on all staff to supply the follo#ing details! #hich #ill e treated in the strictest confidence$ )n order to ensure confidentiality please fold the form in half and staple$ Thank you for your co-operation Choose the appropriate o" Ethnic !roup *hite + British *hite + )rish *hite + ,ther %i"ed -ace . *hite / Blac( Cari ean %i"ed -ace . *hite / Blac( 0frican %i"ed -ace . *hite / 0sian %i"ed -ace . ,ther 0sian10sian British.)ndian 0sian10sian British.2a(istani 0sian10sian British.Bangladeshi 0sian10sian British.,ther Blac(1Blac( British.Cari ean Blac(1Blac( British.0frican Blac(1Blac( British.,ther Chinese 0ny ,ther )nformation refused Se" Nationality %ale Female

0re you disa led or do you have any condition that may re&uire ad3ustments to your #or( or #or(ing environment4 (5"amples of a 6condition7 may include impairment of senses! co.ordination! memory! mo ility! learning! health or #ell eing$ ) 8es No

()f you have tic(ed yes! you #ill e contacted y UCL7s ,ccupational 9ealth Service to assess your re&uirements and to advise your manager of any reasona le ad3ustments that are needed) ) do consider myself to have a disa ility! ut ) do not #ish this information to e shared #ith anyone else$ 8es No ()f you have tic(ed yes! ut re&uire reasona le ad3ustments in the future! it is your responsi ility to inform UCL through your manager)