Membership application form

Please complete and submit the form below.

First Name(s)

Last Name

Former Name

Date of Birth

Gender

National Insurance Number

Member Type Police Officer Police Staff

Force/Organisation

Date Joined Service

Collar/Warrant Number

Pay/Door Number

Previous Force/Organisation

Date Transferred

Status

Date Retired (if applicable)

Address Line 1

Address Line 2

Address Line 3

Address Line 4

Address Line 5

Postcode

Home Telephone

Mobile

Work Telephone

Email Address

Confirm Email Address

Work Email Address

I consent to The Ben Fund storing my personal data for the purposes of processing my membership application.

Please indicate how you would like to be contacted:

Phone calls Emails Post