EmailMe Form - Domestic Membership Application

Domestic Membership Application

Please enter your details

About You
Title *
Forename *
Middle Name
Surname *
Former/Maiden Name
House No. / Name *
Postcode *
Email *
Phone Number *
Mobile Phone Number
Date of Birth *
DD / MM / YYYY
Gender *
Nationality *
Upload a copy of your Work Permit if not of UK origin
Upload a digital Photo of yourself *
Upload a copy of either your Driving Licence, Passport or Birth Certificate *
Passport Number
CRB/DBS Check *
Please Note:
1. Both Pages of the Document are required
2. Scanned images or photographs need to be of the whole document and of clear unblurred quality
3. Energy assessors must have evidence they have been subjected to a Criminal/Basic Disclosure within the past 12 months.

Not got a Basic DBS Check? Click Here
Page 2
(If Seperate)
About your Employer / Company
Employers/Company Name *
Address Line 1 *
Address Line 2
Address Line 3
Post Town *
Postcode *
Website
Insurance Details *
I would like Pay Per Click Insurance
I have my own Insurance Policy
Upload Insurance Certificate *
Accreditation your applying for
Please select the strands you wish to apply for
Accreditation Strands *
Domestic EPC
Application Route (Qualification / APEL) *
Application Region
England & Wales
Northern Ireland
Scotland
Your Qualifications
Qualification *
Certificate Number *
Date Awarded / Issued *
DD / MM / YYYY
Training Centre *
Awarding Body *
Upload a Copy of the Certificate *
Do you need to upload another certificate? *
Yes
No
Qualification *
Certificate Number *
Date Awarded / Issued *
DD / MM / YYYY
Training Centre *
Awarding Body *
Upload a Copy of the Certificate *
Software you are qualified to use
Energy Performance Certificate Software
LifespanRdSAP
Details of Professional Conduct
Have you ever been convicted of a criminal offence in the UK or elsewhere? *
Yes
No
Please provide detials *
Have you had an application to another accreditation scheme or professional body refused at ant time? *
Yes
No
Please provide details *
Have any allegations of Breach of Professional Duty, any complaints or any claims been notified in the last 5 years, or are any actions pending? *
Yes
No
Please provide details *
Have you ever been refused Professional Indemnity insurance, or have any additional clauses and limits been imposed upon you? *
Yes
No
Please provide details *
Have you ever been disqualified as a Director *
Yes
No
Please provide details *
Have you ever had bankruptcy proceedings against you? *
Yes
No
Please provide details *
Have you ever been suspended or has your membership revoked by another accreditation scheme? *
Yes
No
Please provide details *
Are you currently a member of any other accreditation scheme? *
Yes
No
Please provide details including reasons for applying to an additional accreditation body *
Continuous Professional Development
Please provide details of all the CPD you have done in the last 2 years *
Upload a copy of your Lifelong Learning record
Declaration
Please read and tick the box
I understand and agree that information regarding the status of my membership with Sterling will be shared with DCLG, the Register Operator and other schemes who I am also registered with.
Yes
Please enter todays date *
DD / MM / YYYY