SMA4 - Scheme Membership Application: CSH v2.0

1 Introduction
This application form is for customer who wish to join Elmhurst Energy’s certification scheme, existing members who wish to extend the scheme services they offer under and existing membership, and existing members who wish to change their company name for the following scheme:

• Code for Sustainable Homes

Note: A new application is required to action a change in Company Name. If you need to alter other details, such as address, email etc, please complete the relevant Change of Details form on the Elmhurst Energy website.

Once you have completed the application form and submitted it, we will review the information provided to us and aim to process your application within 3 working days of receipt.

Supporting Documentation: It is expected that you can provide (were required) digital/scanned copies of documentation. We are also able to accept photos of if you cannot provide a digital or scanned copy of your documents. These electronic documents must be in colour and must be clear and legible. If the documents are not, this will delay your application as we will be required to get new copies from you.

Should you need to issue a paper document to us, these should be posted to:

FAO Customer Services Team
Elmhurst Energy Systems Ltd
16 St Johns Business Park
Lutterworth, LE17 4HB
1.1 Member Pack
Before completing this application form, you must read the Members Pack for the relevant scheme you wish to apply for. The Members Pack can be download from the Elmhurst Energy website, or directly download from the following links:

• Code for Sustainable Homes Assessors Members Pack
2 Register, Extension of Schemes Held & Change of Company Name
2.1 Application Route
Please mark one of the following options which best describes your application route:
Route *

Route New Application Existing Member: Application to extended schemes held Transfer: Application to transfer from anther Certification Scheme
If you have chosen ‘Existing Member’ from Section 2.1 above, please record the existing membership numbers you wish to update - Please do not list any you do not wish to update:
Membership Number(s) *
If you have chosen ‘Transfer’ from Section 2.1 above, please record the name of the Certification Body below:
Certification Body Name *
2.3 Personnel Information - The Named Assessor
Personnel Information - Part A Personnel Information - Part A * Title First Middle Last Suffix
Date of Birth Date of Birth * / DD / MM YYYY
Personnel Information - Part B Personnel Information - Part B *
Street Address Address Line 2 City County Postcode Country
Personnel Information - Part C
Email Address *
Home Telephone No. *
Mobile Telephone No. *
2.4 Company Information - The Assessment Organisation - To be Invoiced
Company Information - Part D
Company Name* *
Trading Name (if different to Company Name)
Company Registration Number**
* If you are a sole trader, please input your name, or a company name you wish to operate under.
** This is only required if your company is registered with Companies House.
Company Information - Part E Company Information - Part E *
Street Address Address Line 2 City County Postcode Country
Company Information - Part F
Company Email Address *
Company Telephone No.
Company Mobile Telephone No.
Company Website
2.6 Code for Sustainable Homes Assessor Register
Elmhurst Energy operates a database that will be made available upon request. Upon this list, your name and company contact details can be published. This is an opt-in service to assist the public in locating Certified Code Assessors.
Confirmation *

Confirmation Opt-In: Please include my relevant details in the CSH Public Database Opt-Out: Please do not include my relevant details in the CSH Public Database
NOTE: If you do not opt-in, we are still required to list your name, company name and memberhsip number to confirm you are registered. No contact details will be listed however against this information.
3 Identification Check
You are required to provide a colour copy of either your passport or driving license. Please indicate below which item you will be providing:
Identity Check *

Identity Check Passport Driving License Unable to Provide
Please upload a clear, colour copy of the document indicated above.

Attach Files

Please keep individual uploads less than 1MB per file
If you have selected ‘Unable to Provide’ the above documents, we are able to accept a copy of your birth certificate and two recent utility bills.

Please note where this is the case, a professional interview will be conducted with prospective candidates and a signed declaration will be required stating you have neither a passport nor driving license available at the time of application. Please indicate below with an ‘X’ which that you will be providing these documents:
Please upload a clear, colour copy of your birth certificate.

Attach Files

Please keep individual uploads less than 1MB per file
Please upload a clear, colour copy of 2 utility bills.

Attach Files

Please keep individual uploads less than 1MB per file
4 Previous Applications
Have you ever had an application for certification rejected or been suspend or revoked by Elmhurst Energy or another Scheme? A list of the relevant schemes is in Section 1 above. Please indicate below, your answer:
Confirmation *

Confirmation Yes No
Please provide details below:
*
Please continue with your application and a member of Elmhurst Energy will contact you on receipt to discuss this further.
All applications received will be compared to information supplied by other certification schemes and Elmhurst Energy reserve the right to reject any application.
5 Insurance
You are not required to provide insurance documentation to Elmhurst Energy for this scheme. We do however strongly advise you have appropriate Professional Indemnity (PI) and Public Liability (PL) in place to cover your business activities.
6 Scheme Application
You will be required to provide proof of competence. A clear copy of your qualification should be sent with your application to Elmhurst Energy. This can be a clear digital or scanned copy, or a clear photo of each page.

Note: Code for Sustainable Homes is only available in England, Wales and Northern Ireland.
Please upload a clear, colour copy of your Qualification.

Attach Files

Please keep individual uploads less than 1MB per file
7 Code of Conduct Declaration
To complete your application, you are required to read the Code of Conduct, and provide confirmation this has been undertaken (below).

Download a copy of the Code of Conduct Declaration
Agreement *

Agreement I confirm I have read, understand and agree to the terms of the Code of Conduct.
8 Permission to Contact
We like to keep in touch with our clients by post, phone, email and other electronic means with industry news, exclusive offers, events details, CPDs and the latest information from Elmhurst Energy Systems Ltd. Please be assured we’ll treat your information with the utmost care and will not share your information with other companies for marketing purposes without your express permission. For more information about how we’ll use your data, please visit the Elmhurst Energy website, and scroll to the bottom of the page for ‘Privacy Policy’.

Please confirm if you would like us to contact you or not from the options below:
Permission *

Permission I do want to hear about industry news, offers, CPDs/events and Elmhurst Energy information I do not want to hear about industry news, offers, CPDs/events and Elmhurst Energy information
You can update your permissions status at any time for receiving communications from Elmhurst Energy by contacting the Marketing Team.
9 Applicants Declaration
I declare that the all information provided within this document is true to the best of my knowledge. I confirm that I have read and understood all policies, terms and documentation provided within the scheme Members Pack, including specifically this document (SMA4), and the Code of Conduct Declaration Agreement Form.

I promise to abide by all rules and ensure that all terms, conditions and standards currently defined within these polices, terms and documentation will be fully adhered to. I also accept that this ‘Scheme Membership Application’ (and all other policies, terms and documentations within the Members Pack) may be altered in the future by Elmhurst Energy Systems Ltd (Elmhurst Energy will notify the applicant of any changes made) and agree to abide by all subsequent changes made. The information on this form supersedes all previous versions.

Elmhurst Energy will ensure compliance with the General Data Protection Regulation (GDPR) when processing the personal information that you have included within this document. Elmhurst Energy will only use this information in accordance with the training provider and/ or certification scheme requirements and to contact you about other opportunities with Elmhurst Energy if you have given permission for this to happen. If you would like to find out more information about Elmhurst Energy’s compliance with GDPR and your personal data, please visit the Elmhurst Energy website, and scroll to the bottom of the page for ‘Privacy Policy’. If you have any questions concerning data protection or the use of your personal data, please contact us before submitting this document.

Furthermore, I confirm that by signing below, I hereby agree that my company details will be published on the Elmhurst Energy website as part of my on-going certification and shared with other Schemes, and the UK Government and its developed administrations where required.

I confirm I am duly authorised to act on behalf of the business to be invoiced, and I understand that I will be held personally liable in the event that I am not authorised to act on behalf of this entity.
Please tick to confirm *

Please tick to confirm I confrim i am duly authorised.
10 Supporting Documents Summary
Please indicate below which items you have sent (If any) in via post. All other items should be issued with your application, or marked as NA.

Scheme & Route
Scheme & Route	With Application	Sent in by Post	NA
Passport or Driving License	Passport or Driving LicenseWith Application	Passport or Driving LicenseSent in by Post	Passport or Driving LicenseNA
Qualification Certificate	Qualification CertificateWith Application	Qualification CertificateSent in by Post	Qualification CertificateNA

For items listed above that will be sent in by post, please confirm:
Please tick to confirm

Please tick to confirm I confirm I will be posting all required documents to Elmhurst Energy Systems Ltd within the next 7 working days.
Note: Any items sent to Elmhurst Energy will be retained and we are unable to return them.

Ideally all items should be sent via recorded delivery to ensure they can be tracked in case of loss.
Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Elmhurst Energy Systems Ltd

Issued Date: 18/09/2024
Issue Revision: v2.0

SMA4 - Scheme Membership Application: CSH v2.0

SMA4 - Scheme Membership Application: CSH v2.0

2 Register, Extension of Schemes Held & Change of Company Name
2.1 Application Route
Please mark one of the following options which best describes your application route:

If you have chosen ‘Existing Member’ from Section 2.1 above, please record the existing membership numbers you wish to update - Please do not list any you do not wish to update:

If you have chosen ‘Transfer’ from Section 2.1 above, please record the name of the Certification Body below:

2.3 Personnel Information - The Named Assessor

2.4 Company Information - The Assessment Organisation - To be Invoiced

* If you are a sole trader, please input your name, or a company name you wish to operate under.
** This is only required if your company is registered with Companies House.

2.6 Code for Sustainable Homes Assessor Register
Elmhurst Energy operates a database that will be made available upon request. Upon this list, your name and company contact details can be published. This is an opt-in service to assist the public in locating Certified Code Assessors.

NOTE: If you do not opt-in, we are still required to list your name, company name and memberhsip number to confirm you are registered. No contact details will be listed however against this information.

3 Identification Check
You are required to provide a colour copy of either your passport or driving license. Please indicate below which item you will be providing:

4 Previous Applications
Have you ever had an application for certification rejected or been suspend or revoked by Elmhurst Energy or another Scheme? A list of the relevant schemes is in Section 1 above. Please indicate below, your answer:

Please provide details below:

Please continue with your application and a member of Elmhurst Energy will contact you on receipt to discuss this further.

All applications received will be compared to information supplied by other certification schemes and Elmhurst Energy reserve the right to reject any application.

5 Insurance
You are not required to provide insurance documentation to Elmhurst Energy for this scheme. We do however strongly advise you have appropriate Professional Indemnity (PI) and Public Liability (PL) in place to cover your business activities.

7 Code of Conduct Declaration
To complete your application, you are required to read the Code of Conduct, and provide confirmation this has been undertaken (below).

Download a copy of the Code of Conduct Declaration

You can update your permissions status at any time for receiving communications from Elmhurst Energy by contacting the Marketing Team.

10 Supporting Documents Summary
Please indicate below which items you have sent (If any) in via post. All other items should be issued with your application, or marked as NA.

For items listed above that will be sent in by post, please confirm:

Note: Any items sent to Elmhurst Energy will be retained and we are unable to return them.

Ideally all items should be sent via recorded delivery to ensure they can be tracked in case of loss.

Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Elmhurst Energy Systems Ltd

Issued Date: 18/09/2024
Issue Revision: v2.0

SMA4 - Scheme Membership Application: CSH v2.0

SMA4 - Scheme Membership Application: CSH v2.0

2 Register, Extension of Schemes Held & Change of Company Name 2.1 Application Route Please mark one of the following options which best describes your application route:

If you have chosen ‘Existing Member’ from Section 2.1 above, please record the existing membership numbers you wish to update - Please do not list any you do not wish to update:

If you have chosen ‘Transfer’ from Section 2.1 above, please record the name of the Certification Body below:

2.3 Personnel Information - The Named Assessor

2.4 Company Information - The Assessment Organisation - To be Invoiced

* If you are a sole trader, please input your name, or a company name you wish to operate under. ** This is only required if your company is registered with Companies House.

2.6 Code for Sustainable Homes Assessor Register Elmhurst Energy operates a database that will be made available upon request. Upon this list, your name and company contact details can be published. This is an opt-in service to assist the public in locating Certified Code Assessors.

NOTE: If you do not opt-in, we are still required to list your name, company name and memberhsip number to confirm you are registered. No contact details will be listed however against this information.

3 Identification Check You are required to provide a colour copy of either your passport or driving license. Please indicate below which item you will be providing:

4 Previous Applications Have you ever had an application for certification rejected or been suspend or revoked by Elmhurst Energy or another Scheme? A list of the relevant schemes is in Section 1 above. Please indicate below, your answer:

Please provide details below:

Please continue with your application and a member of Elmhurst Energy will contact you on receipt to discuss this further.

All applications received will be compared to information supplied by other certification schemes and Elmhurst Energy reserve the right to reject any application.

5 Insurance You are not required to provide insurance documentation to Elmhurst Energy for this scheme. We do however strongly advise you have appropriate Professional Indemnity (PI) and Public Liability (PL) in place to cover your business activities.

7 Code of Conduct Declaration To complete your application, you are required to read the Code of Conduct, and provide confirmation this has been undertaken (below). Download a copy of the Code of Conduct Declaration

You can update your permissions status at any time for receiving communications from Elmhurst Energy by contacting the Marketing Team.

10 Supporting Documents Summary Please indicate below which items you have sent (If any) in via post. All other items should be issued with your application, or marked as NA.

For items listed above that will be sent in by post, please confirm:

Note: Any items sent to Elmhurst Energy will be retained and we are unable to return them. Ideally all items should be sent via recorded delivery to ensure they can be tracked in case of loss.

Produced By: Steven Marriott Authorised By: Sam Cantle On behalf of Elmhurst Energy Systems Ltd Issued Date: 18/09/2024 Issue Revision: v2.0

2 Register, Extension of Schemes Held & Change of Company Name
2.1 Application Route
Please mark one of the following options which best describes your application route:

* If you are a sole trader, please input your name, or a company name you wish to operate under.
** This is only required if your company is registered with Companies House.

2.6 Code for Sustainable Homes Assessor Register
Elmhurst Energy operates a database that will be made available upon request. Upon this list, your name and company contact details can be published. This is an opt-in service to assist the public in locating Certified Code Assessors.

3 Identification Check
You are required to provide a colour copy of either your passport or driving license. Please indicate below which item you will be providing:

4 Previous Applications
Have you ever had an application for certification rejected or been suspend or revoked by Elmhurst Energy or another Scheme? A list of the relevant schemes is in Section 1 above. Please indicate below, your answer:

5 Insurance
You are not required to provide insurance documentation to Elmhurst Energy for this scheme. We do however strongly advise you have appropriate Professional Indemnity (PI) and Public Liability (PL) in place to cover your business activities.

7 Code of Conduct Declaration
To complete your application, you are required to read the Code of Conduct, and provide confirmation this has been undertaken (below).

Download a copy of the Code of Conduct Declaration

10 Supporting Documents Summary
Please indicate below which items you have sent (If any) in via post. All other items should be issued with your application, or marked as NA.

Note: Any items sent to Elmhurst Energy will be retained and we are unable to return them.

Ideally all items should be sent via recorded delivery to ensure they can be tracked in case of loss.

Produced By: Steven Marriott

Authorised By: Sam Cantle

On behalf of Elmhurst Energy Systems Ltd

Issued Date: 18/09/2024
Issue Revision: v2.0