Bupa recognition:

confirmation of identity form

Please complete this form to confirm your identity when applying for Bupa recognition.
1. You can send us scanned copies of any of the following to prove your identity:
• valid passport • valid photo card driving licence
• national identity card • identity card issued by the Electoral Office for
Northern Ireland
Or if you are unable to provide photographic proof of identity, you can send us a certified copy of two
of the following documents:
• utility bill showing your name and • your most recent mortgage statement from
address a recognised lender
• bank, building society or credit union • a paper UK driving licence issued before 1998 (not
statement the counterpart to the photocard driving licence)
We are unable to accept mobile phone bills or any printed bills or statements downloaded from the
internet.
2. Please ask a Member of Parliament, Justice of the Peace, minister of religion, a
professionally qualified person (such as a doctor, engineer, lawyer, teacher), local
councillor, bank officer, established civil servant, or police officer to confirm your identity
by completing and signing this form.
The person confirming your identity should have personally known you for at least two years and not
be a relative (this includes spouses, partners, in-laws, and step-parents).
Please upload this to your online application along with your other supporting documents.

1. Applicant

Name:

Specialty:

2. Details of person confirming identity

Name:

Profession:

Company/organisation name:
Business/professional email address:
Signature: Date:

Stamp of endorsement or company address:

If you have any questions, please call 0345 600 5422. Lines are open Monday to Friday, 8am and 4pm.
Calls may be recorded and may be monitored.