City of Stoke On Trent Branch

TO BECOME A MEMBER OF UNISON NOW PLEASE PRINT THIS FORM AND COMPLETE ALL RELEVANT BOXES. (WE CANNOT ACCEPT E- MAILS BECAUSE WE REQUIRE AN ORIGINAL COPY WITH AN ORIGINAL SIGNATURE ON IT).  THIS FORM IS APPROPRIATE FOR ALL COUNCIL EMPLOYEES WHO ARE ABLE TO PAY DIRECTLY OUT OF THE SALARIES/WAGES VIA THE COUNCIL PAYROLL.  IF YOU ARE NOT PAID VIA THE STOKE OF TRENT CITY COUNCIL PAYROLL, PLEASE CONTACT US AS WE WILL NEED TO SEND AN APPLICATION FORM TOGETHER WITH A DIRECT DEBIT MANDATE IN THE POST TO YOU.

YOUR PERSONAL DETAILS

Title (Mrs, Ms, Miss, Mr, Other) 

 

  Firstname(s) & Other Initials
Surname/Family Name

 

 Date of birth
Home Address

 
  Postcode

 
National Insurance Number (from your payslip)

 

  
Please tick this box if you require materials in a different format (eg large print of Braille) - be sure to supply contact details below.  
Contact tel/voice/text/email

 

YOUR EMPLOYMENT DETAILS

Employer's Name

 

  
Your job title/occupation

 

  
Department/section

 

  
Address

 

  
continue address here is more space needed Postcode

 

 Payroll no (from your payslip)

WHAT YOU WILL PAY - CURRENT RATES (SET 1 OCTOBER 2003

Weekly Pay Tick box for earnings before stoppages Annual Pay What you will pay per week What you will pay per 4 weeks What you will pay per month Band
Up to £38.47   Up to £2,000 £0.30 £1.20 £1.30 A
£38.48-96.16   £2001-5000 £0.81 £3.24 £3.50 B
£96.17-153.84   £5001-8000 £1.22 £4.88 £5.30 C
£153.85-211.53   £8001-11000 £1.52 £6.08 £6.60 D
£211.54-269.23   £11001-14000 £1.81 £7.24 £7.85 E
£269.24-326.92   £14001-17000 £2.24 £8.96 £9.70 F
£326.93-384.61   £17001-20000 £2.65 £10.60 £11.50 G

£384.62-480.76

  

£20001-25000

 £3.23 £12.92 £14.00

H

£480.77-576.92

  

£25001-30000

 £3.98 £15.92 £17.25

I

£576.93-673.08

  

£30001-35000

 £4.68 £18.72 £20.30

J

£673.09+

  

Over £35000

 £5.19 £20.76 £22.50

K
Tick box if you are a student member in  FULL TIME education including student nurses) but NOT on secondment.  Your subscription is £10 per year.  
Are you paid Weekly/Fortnightly/Four Weekly or Monthly?

POLITICAL FUND

(Unison is affiliated to the Labour Party, locally and nationally,through the Affiliated Political Fund (APF) This link promotes the views of our members and the needs of the public services within the Labour Party, in Parliament and in Europe.  Unison's General Political fund (GPF) is used to pay for campaigning at branch, regional and national levels of the union and for research and lobbying in Parliament and Europe. It is independent of support for any political party. IT IS IMPORTANT THAT YOU INDICATE A CHOICE OF FUND BY TICKING ONE OF THE BOEX BELOW, OTHERWISE YOU WILL BE ALLOCATED TO A FUND BY THE UNION. yoUR SUBSCRIPTION SHOWN ABOVE INCLUDES A POLITICAL FUND PAYMENT.
If you have been a member of a TU before, please state which one:
The information provided by you shall be recorded by UNISON for statistical purposes and used for sending you UNISON publications, ballot forms and otherwise communicating with you.  If you do NOT want any mailings from UNISON, besides those required by status, please tick the box.    
To keep you fully informed of the services we arrange for members we want you to receive details of benefits offered by or in conjunction with UNISON's affinity partners. The affinity partners are organisations with close links to UNISON that share our ambitions to provide you with the best possible range of benefits. Under the Data Protection legislation we can only disclose your details to our affinity partners with your explicit consent. Therefore if you WANT to receive details of the full range of benefits you MUST tick this box.  
 

 

YOUR AUTHORISATION

Affiliated Political Fund   General Political Fund  

Now please sign and date below:

Signed ................................................................................   Date ........................

Please check before returning your form you have completed the following:

Please return your completed form to:

Unison City of Stoke On Trent Branch 40 Kingsway, Stoke, Stoke On Trent ST4 1JH

Your application will now be processed at our next Executive meeting (4-6 weekly intervals) and you will then receive a welcome letter to the branch and a temporary membership card until you are issued with your official membership number from our Regional Office in Birmingham. Your subscriptions will start to be deducted some 2-4 weeks after the receipt of your welcome letter.

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