HWMA Membership Application Form

Name of Applicant Company

Address for Correspondence

Email Address

Telephone

Company Type Company Type Sole Trader Partnership Limited Co. Other

Public Contact Name

Alternative Contact

Date Commenced Trading

Names of all Directors / Partners / Owners

Please specify if any of the above named persons been involved in any bankruptcies, liquidations or winding-up proceedings (except for purposes of reconstruction of a company), being principals of the firm/company within the past five years?

If the company is a subsidiary, please name holding company and ultimate parent group

Which of the following disposal activities are relevant to your Company operations Which of the following disposal activities are relevant to your Company operations Clinical waste Sharps Pharmaceutical Chemical General waste

Which of the following services are relevant to your Company operations Which of the following services are relevant to your Company operations Hygiene Sanitary Equip. manuf. Container sales Chem. products Other

Which sector most closely describes your business?

Total number of employees in Applicant company Total number of employees in Applicant company1-56-1011-2021-5051-100100-250251+

Total number of employees in Overall group Total number of employees in Overall group1-56-1011-2021-5051-100100-250251+

Employees directly involved in Disposal Employees directly involved in Disposal1-56-1011-2021-5051-100100-250251+

Employees directly involved in Collection Employees directly involved in Collection1-56-1011-2021-5051-100100-250251+

Employees directly involved in Hygiene services Employees directly involved in Hygiene services1-56-1011-2021-5051-100100-250251+

Do you use agents, sub-contractors or franchisees in activities of disposal, collection or hygiene services? Do you use agents, sub-contractors or franchisees in activities of disposal, collection or hygiene services? Yes No

Do you carry Public Liability Insurance cover? Do you carry Public Liability Insurance cover? Yes No

Limit of liability (£)

Name of Insurers

Policy Number

Name and address of Brokers

Have you applied for membership of HWMA before? Have you applied for membership of HWMA before? Yes No

Upon acceptance of your application, do you agree to comply with all Acts of Parliament, Statutes, Regulations, and Codes of Practice relevant to this industry? Upon acceptance of your application, do you agree to comply with all Acts of Parliament, Statutes, Regulations, and Codes of Practice relevant to this industry? Yes No

Upon acceptance of your application, will you ensure company attendance at a minimum of one main or working group/street guide meeting each year? Upon acceptance of your application, will you ensure company attendance at a minimum of one main or working group/street guide meeting each year? Yes No

Name of Member Company - 1

Contact Name – 1

Telephone Number - 1

Name of Member Company - 2

Contact Name – 2

Telephone Number - 2

Please provide a statement identifying the contribution that your Company intends to bring to the Association

Please provide a statement which demonstrates how your Company is able to meet the Association’s Code of Conduct

Please provide documentary evidence that your Company is able to meet the Association’s Code of Conduct: (please list any supporting documents and attach a copy e.g. H&S policy, Environmental policy, licenses etc.)

For applicants Accredited to approved Quality, Environmental or H&S management schemes (e.g. ISO 9000, ISO 14000) please provide details of accreditation, extent of certification and awarding body, and attach copies of relevant certificates.

Please confirm how your organisation heard about the HWMA